| NPI | 1063480473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A21571) |
| Additional Taxonomies | 207NS0135X Dermatology Procedural Dermatology (Licence: CA A21571) |
| 207ND0900X Dermatology Dermatopathology (Licence: CA A21571) | |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2010-06-04 |