| NPI | 1578673893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: GA 17909) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: GA 17909) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2010-10-26 |