| NPI | 1679054043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: RI LA00016) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CT 61812) |
| Enumeration Date | 2018-08-23 |
| Last Update Date | 2020-01-03 |