| NPI | 1669686804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX N3612) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: AL 27636) |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2011-11-08 |