| NPI | 1407048515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: UT 7284767-1205) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: PA MT192221) |
| Enumeration Date | 2007-08-13 |
| Last Update Date | 2024-09-13 |