| NPI | 1518222082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MO 2015011824) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL UO2949) |
| Enumeration Date | 2012-07-10 |
| Last Update Date | 2021-09-10 |