| NPI | 1013902907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TN MD17098) |
| Additional Taxonomies | 207NP0225X Dermatology Pediatric Dermatology (Licence: TN MD17098) |
| 207NS0135X Dermatology Procedural Dermatology (Licence: TN MD17098) | |
| 207R00000X Internal Medicine (Licence: TN MD17098) | |
| Enumeration Date | 2005-09-16 |
| Last Update Date | 2020-04-03 |