| NPI | 1043599269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: RI MD14907) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: RI MD14907) |
| Enumeration Date | 2011-08-04 |
| Last Update Date | 2015-05-07 |