| NPI | 1992780761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WI 77966) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: CO 34731) |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2023-10-30 |