| NPI | 1689625766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL 0066054) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL 0066054) |
| Enumeration Date | 2006-05-13 |
| Last Update Date | 2017-02-22 |