| NPI | 1689899742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: RI MD12497) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MA 234259) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2013-01-14 |