| NPI | 1962676353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WY 8582A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR LL17128) |
| Enumeration Date | 2008-04-16 |
| Last Update Date | 2012-08-13 |