| NPI | 1558349852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: ID M-11642) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A 93571) |
| 207N00000X Dermatology (Licence: ID M-11462) | |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2020-10-01 |