| NPI | 1588839765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME112838) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PR 5112) |
| 183500000X Pharmacist (Licence: FL PS39927) | |
| 207N00000X Dermatology (Licence: PR 18797) | |
| Enumeration Date | 2008-04-28 |
| Last Update Date | 2020-07-09 |