| NPI | 1518490283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MT MED-PHYS-LIC-109898) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: UT 10955715-1205) |
| Enumeration Date | 2017-04-09 |
| Last Update Date | 2022-08-29 |