| NPI | 1871749648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NV DO1715) |
| Additional Taxonomies | 174400000X Specialist (Licence: NV SL0590) |
| Enumeration Date | 2008-08-13 |
| Last Update Date | 2018-03-26 |