| NPI | 1487741070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: FL ME23235) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: FL ME 23235) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2023-06-15 |