| NPI | 1841201829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CO 24723) |
| Additional Taxonomies | 174400000X Specialist (Licence: CO 24723) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2011-12-16 |