| NPI | 1558569087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX H8330) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA C53567) |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2011-06-23 |