| NPI | 1699716860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: WA MD60604269) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: CA A65177) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2021-04-13 |