| NPI | 1750491494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME69164) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX J3999) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2015-06-08 |