| NPI | 1790856854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: AZ 11286) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: AZ 11286) |
| Enumeration Date | 2006-11-12 |
| Last Update Date | 2007-09-28 |