| NPI | 1700889177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: LA 020084) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: LA 020084) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2011-05-25 |