| NPI | 1033112453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: KY 21532) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: KY 21532) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2013-12-16 |