| NPI | 1609263797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 2023-03183) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: PA MD468023) |
| Enumeration Date | 2015-04-16 |
| Last Update Date | 2026-01-21 |