| NPI | 1477649754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX K1811) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: TX K1811) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2021-06-07 |