| NPI | 1831158385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NM MD2015-0592) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX H6065) |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2020-10-23 |