| NPI | 1962753517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CT 026638) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA G62228) |
| Enumeration Date | 2012-09-23 |
| Last Update Date | 2012-09-23 |