| NPI | 1225213432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CO DR.0047867) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OR ll16967) |
| 207N00000X Dermatology (Licence: CA A109366) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: CO 47867) | |
| Enumeration Date | 2008-01-07 |
| Last Update Date | 2023-02-15 |