| NPI | 1740265172 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA C32355) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: CA C32355) |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2010-02-22 |