| NPI | 1912090143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: LA 14710R) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MS 17858) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2014-02-05 |