| NPI | 1760470496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0102050098) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 50098) |
| 202K00000X Phlebology (Licence: VA 0102050098) | |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2011-02-02 |