| NPI | 1174520597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207NS0135X Dermatology Procedural Dermatology (Licence: UT 182204-8905) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: UT 182204-1205) |
| 207ND0900X Dermatology Dermatopathology (Licence: UT 182204-8905) | |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2014-04-25 |