| NPI | 1144294208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: ND 10283) |
| Additional Taxonomies | 207NS0135X Dermatology Procedural Dermatology (Licence: MN 43597) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2020-01-20 |