| NPI | 1326200569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: TX P8471) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX P8471) |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2019-02-06 |