| NPI | 1649585639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: FL OS12533) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: PA OT013899) |
| Enumeration Date | 2010-08-13 |
| Last Update Date | 2014-07-30 |