| NPI | 1295552388 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA LT001042) |
| Additional Taxonomies | 207NP0225X Dermatology, Pediatric Dermatology (Licence: PA LT001042) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: PA LT001042) | |
| Enumeration Date | 2024-09-20 |
| Last Update Date | 2025-01-19 |