| NPI | 1952628471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: GA 069779) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 069779) |
| Enumeration Date | 2010-04-23 |
| Last Update Date | 2019-02-19 |