| NPI | 1922292796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: VA 0101244548) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101244548) |
| 286500000X Military Hospital | |
| Enumeration Date | 2007-09-05 |
| Last Update Date | 2025-08-07 |