| NPI | 1467430231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TN MD0000013982) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: VA 0101029043) |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2008-04-28 |