| NPI | 1831355700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AL MD44576) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: HI 15264) |
| 207N00000X Dermatology (Licence: KY 48481) | |
| Enumeration Date | 2008-07-31 |
| Last Update Date | 2022-07-11 |