| NPI | 1235134412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ 2012) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: AZ 2012) |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: AZ 2012) | |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2022-02-09 |