| NPI | 1780904300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NV 14219) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX BP10033277) |
| Enumeration Date | 2010-06-04 |
| Last Update Date | 2013-06-13 |