| NPI | 1639286339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207NP0225X Dermatology, Pediatric Dermatology (Licence: TX J7330) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX J7330) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2025-07-28 |