| NPI | 1578041299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PR 023545) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WA 61691332) |
| Enumeration Date | 2018-08-03 |
| Last Update Date | 2025-12-02 |