| NPI | 1386681005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207N00000X Dermatology (Licence: UT 1620901205) |
| Additional Taxonomies | 207NS0135X Dermatology Procedural Dermatology (Licence: UT 1620908905) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2007-07-09 |