| NPI | 1649356940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MD D0087639) |
| Additional Taxonomies | 174400000X Specialist (Licence: VA 0101033623) |
| Enumeration Date | 2006-10-29 |
| Last Update Date | 2019-06-11 |