| NPI | 1811448251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA 187393) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: RI LP04899) |
| Enumeration Date | 2016-10-20 |
| Last Update Date | 2023-08-25 |