| NPI | 1659512366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL OS10492) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL OS 10492) |
| Enumeration Date | 2009-03-10 |
| Last Update Date | 2022-03-04 |