| NPI | 1780690487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CO 51164) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NM 90-145) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2013-10-30 |