| NPI | 1740302868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA C36061) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: CA c36061) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2018-08-13 |