| NPI | 1164462461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: RI MD6829) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: RI MD6829) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2015-06-23 |