| NPI | 1083716955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: UT 177611-1205) |
| Additional Taxonomies | 207ND0900X Dermatology Dermatopathology (Licence: UT 177611-1205) |
| 207NP0225X Dermatology Pediatric Dermatology (Licence: UT 177611-1205) | |
| 207NS0135X Dermatology Procedural Dermatology (Licence: UT 177611-1205) | |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2023-03-14 |