| NPI | 1003876285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX H4347) |
| Additional Taxonomies | 207ND0900X Dermatology Dermatopathology (Licence: TX H4347) |
| 207NP0225X Dermatology Pediatric Dermatology (Licence: TX H4347) | |
| 207NS0135X Dermatology Procedural Dermatology (Licence: TX H4347) | |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2014-01-07 |