| NPI | 1477577633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207NS0135X Dermatology Procedural Dermatology (Licence: MO 29675) |
| Additional Taxonomies | 207NI0002X Dermatology Clinical & Laboratory Dermatological Immunology |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2007-07-18 |