| NPI | 1114991296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: KY 16726) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: KY 16726) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2009-01-06 |