| NPI | 1811216807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: LA MD.205161) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA MD.205161) |
| Enumeration Date | 2010-05-31 |
| Last Update Date | 2025-10-16 |