| NPI | 1740359017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MD D0029651) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: VA 0101033804) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2025-05-12 |