| NPI | 1972749505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: DC MD33462) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MD D0050131) |
| Enumeration Date | 2009-01-03 |
| Last Update Date | 2009-01-03 |