| NPI | 1710048483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A086935) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: CA A086935) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2013-09-09 |