| NPI | 1487712295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MO 2007038037) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: IN 01053751A) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2017-01-31 |