| NPI | 1548366727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A68814) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: CA A688140) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2016-11-09 |