| NPI | 1194708289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: CA A20197) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: CA A20197) |
| 207NI0002X Dermatology, Clinical & Laboratory Dermatological Immunology (Licence: CA A20197) | |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: CA 20197) | |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2010-05-26 |