| NPI | 1427221704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: AR E-6521) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: LA MD.205964) |
| Enumeration Date | 2008-04-08 |
| Last Update Date | 2016-10-09 |