| NPI | 1518953074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207NS0135X Dermatology Procedural Dermatology (Licence: MD D0051599) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MD D0051599) |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2023-06-17 |