| NPI | 1306937891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207NS0135X Dermatology Procedural Dermatology (Licence: TN 7152) |
| Additional Taxonomies | 207NS0135X Dermatology Procedural Dermatology (Licence: MS 06637) |
| 207NS0135X Dermatology Procedural Dermatology (Licence: AR R-4673) | |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2023-03-07 |