| NPI | 1598956781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: MI 4301104398) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: AL MD.31128) |
| 207N00000X Dermatology (Licence: TX P8983) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: TX P8983) | |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2016-09-01 |