| NPI | 1598020059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA OP61408379) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL OS13979) |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2024-05-17 |