| NPI | 1871655902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX M2867) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: TX M2867) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2008-03-12 |