| NPI | 1689729550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MD D0065487) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: MD D0065487) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2020-06-09 |