| NPI | 1528708047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A208307) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: CA A208307) |
| Enumeration Date | 2022-03-31 |
| Last Update Date | 2026-08-13 |