| NPI | 1598715567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX F2996) |
| Additional Taxonomies | 207NS0135X Dermatology Procedural Dermatology (Licence: TX F2996) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2007-07-08 |