| NPI | 1649388422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NM MD2017-1059) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: ME 012443) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2023-02-16 |