| NPI | 1982632527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA OS005797L) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: FL OS 4781) |
| 207N00000X Dermatology (Licence: RI DO01051) | |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2021-08-24 |