| NPI | 1669834495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME155353) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: KS 04-43050) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: IL 036.151547) | |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2023-04-05 |