| NPI | 1508940644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: CA C51581) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: MA 54177) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2023-01-12 |