| NPI | 1922466325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PR 19746) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 19746) |
| Enumeration Date | 2016-02-01 |
| Last Update Date | 2022-09-07 |