| NPI | 1174523583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CT 042873) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: CT 042873) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2007-07-09 |