| NPI | 1154301331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MD D40092) |
| Additional Taxonomies | 207NS0135X Dermatology Procedural Dermatology (Licence: MD D40092) |
| Enumeration Date | 2006-01-22 |
| Last Update Date | 2023-03-07 |