| NPI | 1023000692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CO 42490) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: CO 42490) |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2011-05-11 |