| NPI | 1447278262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: OK 6851) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: TX L9203) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2021-01-25 |