| NPI | 1619506961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AL 48398) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OK 38209) |
| Enumeration Date | 2020-04-07 |
| Last Update Date | 2025-08-05 |