| NPI | 1720038342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: VA 0101033724) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: DC MD12067) |
| 207N00000X Dermatology (Licence: VA 0101033724) | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2022-02-08 |