| NPI | 1871974972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A161079) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 264085) |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2019-08-26 |