| NPI | 1124040704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: UT 48332401205) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: UT 48332401205) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2021-11-02 |