| NPI | 1831234400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MO MDR4H54) |
| Additional Taxonomies | 207NS0135X Dermatology Procedural Dermatology (Licence: MO MDR4H54) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2019-07-16 |