| NPI | 1811526379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0101281638) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: VA 0101281638) |
| Enumeration Date | 2020-04-06 |
| Last Update Date | 2024-07-06 |