| NPI | 1376549386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA MD064261L) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: PA MD064261L) |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2023-09-18 |