| NPI | 1124078902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AL M.D.25680) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: AL 25680) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: AL MD25680) | |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2023-12-05 |