| NPI | 1740497700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MI 4301085945) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 4302030952) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2022-02-11 |