| NPI | 1477964005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX R5778) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: TX R5778) |
| Enumeration Date | 2014-05-16 |
| Last Update Date | 2025-08-01 |