| NPI | 1629483516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA 20A14709) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL UO5280) |
| 208600000X Surgery (Licence: TX BP10048758) | |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2024-12-30 |