| NPI | 1649379702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0101235446) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: DC MD034551) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2026-01-29 |