| NPI | 1013368851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX R4974) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TX BP10057604) |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2022-07-13 |