| NPI | 1457001083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A187632) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: CA A187632) |
| Enumeration Date | 2022-03-26 |
| Last Update Date | 2026-07-22 |