| NPI | 1043350531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 2013-02403) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: MI MR039589) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2021-03-08 |