| NPI | 1942265178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MI 4301084275) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: VA 0101258010) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2023-02-28 |