| NPI | 1831279629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD60529122) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: IN 01061136A) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2015-05-18 |