| NPI | 1841653730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME151200) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MD D90061) |
| Enumeration Date | 2016-03-30 |
| Last Update Date | 2021-06-25 |