| NPI | 1669456661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: GA 029001) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: GA 029001) |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2023-03-31 |