| NPI | 1902858525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 058049) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MA 058049) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2012-06-19 |