| NPI | 1326141615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX F0988) |
| Additional Taxonomies | 207NS0135X Dermatology Procedural Dermatology (Licence: TX F0988) |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2007-10-24 |