| NPI | 1851736763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ 008851) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CO 59009) |
| Enumeration Date | 2013-05-06 |
| Last Update Date | 2021-02-01 |