| NPI | 1578641387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: NC 2017-01169) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A80115) |
| 207N00000X Dermatology (Licence: FL ME91819) | |
| 207N00000X Dermatology (Licence: NC 2017-01169) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2023-07-03 |