| NPI | 1952393829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CO 36147) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CO DR.0036147) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: CO 36147) | |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2024-01-09 |