| NPI | 1942583331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PR 18976) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 18976) |
| Enumeration Date | 2011-09-22 |
| Last Update Date | 2024-08-06 |