| NPI | 1366455206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: SC 7540) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TN 40472) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: TN 40472) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: SC 7540) | |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2022-08-19 |