| NPI | 1396804597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: SD 7021) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OH 34-00-8163H) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: SD 7021) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: OH 34-00-8163H) | |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2022-08-19 |