| NPI | 1124261177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: VA 0101252982) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: DC MD041039) |
| Enumeration Date | 2009-04-07 |
| Last Update Date | 2022-02-08 |