| NPI | 1689935918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0101257027) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10044783) |
| Enumeration Date | 2012-06-04 |
| Last Update Date | 2020-12-08 |