| NPI | 1629364112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TN 49508) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TN 49508) |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2018-10-17 |