| NPI | 1093940181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MD D0076177) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: MD D0076177) |
| Enumeration Date | 2009-05-19 |
| Last Update Date | 2018-09-10 |