| NPI | 1891844296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MI 4301038336) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MI DH038336) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2019-09-12 |