| NPI | 1902857980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: KY 19685) |
| Additional Taxonomies | 174400000X Specialist (Licence: KY 19685) |
| Enumeration Date | 2006-05-13 |
| Last Update Date | 2022-03-21 |