| NPI | 1982741021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: CA G85998) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA G85998) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2022-05-17 |