| NPI | 1568423192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: IA MD-25852) |
| Additional Taxonomies | 174400000X Specialist (Licence: IA 25852) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2022-03-28 |