| NPI | 1912907452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA MD052489L) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: PA MD052489L) |
| Enumeration Date | 2005-07-27 |
| Last Update Date | 2015-01-20 |