| NPI | 1356662621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: IA MD-41607) |
| Additional Taxonomies | 207NS0135X Dermatology Procedural Dermatology (Licence: IA MD-41607) |
| Enumeration Date | 2010-06-21 |
| Last Update Date | 2014-04-26 |