| NPI | 1417213299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: FL 139442) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL 139442) |
| Enumeration Date | 2012-04-06 |
| Last Update Date | 2023-03-02 |