| NPI | 1811398431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA OP61030629) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MO 2017022821) |
| Enumeration Date | 2014-09-15 |
| Last Update Date | 2022-07-25 |