| NPI | 1851355184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME33849) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NC 2014-01177) |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2019-10-17 |