| NPI | 1962494807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ 30230) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: AZ 30230) |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2022-12-20 |