| NPI | 1528054095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A87744) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A87744) |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2022-09-07 |