| NPI | 1639494198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MO 2017030249) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: KS 04-37279) |
| Enumeration Date | 2010-03-28 |
| Last Update Date | 2022-08-18 |