| NPI | 1669737011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX R2302) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MA 251397) |
| 207N00000X Dermatology (Licence: PA MT204136) | |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2017-05-22 |