| NPI | 1629483516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL UO5280) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP10048758) |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2016-06-30 |