| NPI | 1700170149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: ME MD20495) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT198848) |
| Enumeration Date | 2011-06-02 |
| Last Update Date | 2016-01-25 |