| NPI | 1710449764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NM MD2024-0189) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CO DR.0072048) |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2024-10-24 |