| NPI | 1952662868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: AL 35179) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MN 57122) |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2016-09-21 |