| NPI | 1033301023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA MD438923) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: NY 169866) |
| 207N00000X Dermatology (Licence: FL ME106820) | |
| 207N00000X Dermatology (Licence: NY 169866) | |
| Enumeration Date | 2007-08-14 |
| Last Update Date | 2023-12-21 |