| NPI | 1982657342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: PA OS013669) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL OS10111) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2010-12-21 |