| NPI | 1649492752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CT 046529) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: CT 046529) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2015-03-09 |