| NPI | 1255630034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 2015-00937) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: NC 2015-00937) |
| Enumeration Date | 2011-03-20 |
| Last Update Date | 2016-02-19 |