| NPI | 1710044789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MD D0020518) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: DC MD10124) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2007-07-08 |