| NPI | 1619183928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX G3056) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX G3059) |
| 2083T0002X Preventive Medicine, Medical Toxicology (Licence: TX G3056) | |
| 208U00000X Clinical Pharmacology (Licence: TX G3056) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2007-07-08 |