| NPI | 1366753865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: AZ 50534) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: RI 14668) |
| 207N00000X Dermatology (Licence: UT 9250806-1205) | |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2015-07-13 |