| NPI | 1740410463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CO 52146) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: CO 0052146) |
| 2083B0002X Preventive Medicine, Obesity Medicine (Licence: CO 52146) | |
| Enumeration Date | 2009-07-15 |
| Last Update Date | 2023-06-01 |