| NPI | 1124201819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: AZ 5845) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: AZ 5845) |
| Enumeration Date | 2007-12-17 |
| Last Update Date | 2019-11-07 |