| NPI | 1134125065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MI 4301043778) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: MI 4301043778) |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2018-10-30 |