| NPI | 1548475189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: VA 0101267201) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: LA MD.203711) |
| 207N00000X Dermatology (Licence: LA MD.203711) | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2019-09-07 |