| NPI | 1750303079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MI 4301074360) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: MI JV074360) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2024-03-28 |