| NPI | 1255465670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A69982) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA A69982) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2024-09-18 |