| NPI | 1790772705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA OS006433E) |
| Additional Taxonomies | 207NS0135X Dermatology Procedural Dermatology (Licence: PA OS006433E) |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2020-08-05 |