| NPI | 1790749836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WY 5252A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WY 5252A) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2023-04-04 |