| NPI | 1689678336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NC 200200111) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NC 200200111) |
| Enumeration Date | 2005-06-10 |
| Last Update Date | 2025-10-19 |