| NPI | 1194303396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX V7044) |
| Additional Taxonomies | 207NS0135X Dermatology Procedural Dermatology (Licence: TX V7044) |
| Enumeration Date | 2021-03-30 |
| Last Update Date | 2025-06-27 |