| NPI | 1023144094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD60153580) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: WA MD60153580) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2020-12-30 |