| NPI | 1619293891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NM MD2018-0585) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: AZ 48969) |
| Enumeration Date | 2010-04-13 |
| Last Update Date | 2021-05-13 |