| NPI | 1821165143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX N9338) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: GA 056951) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: GA 056951) | |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2021-02-10 |