| NPI | 1780946160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TN 63267) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: KY 46761) |
| 207N00000X Dermatology (Licence: TX BP10042769) | |
| 207NS0135X Dermatology Procedural Dermatology (Licence: KY 46761) | |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2024-02-19 |