| NPI | 1548251481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: PA MD428937) |
| Additional Taxonomies | 174400000X Specialist (Licence: MA 223904) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2015-02-13 |