| NPI | 1487625885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL OS8594) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: FL OS8594) |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2023-06-10 |