| NPI | 1982044012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CO 0058495) |
| Additional Taxonomies | 207NS0135X Dermatology Procedural Dermatology (Licence: CO 0058495) |
| Enumeration Date | 2013-07-03 |
| Last Update Date | 2021-10-12 |