| NPI | 1508360421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 317025) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: NY 317025) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: WA MD70023321) | |
| 207N00000X Dermatology (Licence: WA MD70023321) | |
| Enumeration Date | 2018-03-23 |
| Last Update Date | 2026-08-19 |