| NPI | 1528385507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: FL 113817) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL 113817) |
| Enumeration Date | 2010-04-29 |
| Last Update Date | 2025-10-29 |