| NPI | 1730406596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ 44289) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX M3886) |
| Enumeration Date | 2010-05-03 |
| Last Update Date | 2014-06-27 |