| NPI | 1578722476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: VA 0101048517) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: VA 0101048517) |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2008-06-05 |