| NPI | 1528094836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OK 3536) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 3536) |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2019-10-08 |