| NPI | 1821144981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX D5212) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX D-5212) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2026-01-06 |