| NPI | 1770879264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CO CDRH.0059987) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: NE 27098) |
| 207N00000X Dermatology (Licence: NE 27098) | |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2023-07-06 |