| NPI | 1578673166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NE 23843) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: UT 7454874-1205) |
| 207N00000X Dermatology (Licence: TX N4363) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2023-08-07 |