| NPI | 1134224751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA G29102) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: CA G29102) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: CA G29102) | |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2010-10-14 |