| NPI | 1205902855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A44995) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: CA A44995) |
| 207ND0900X Dermatology, Dermatopathology (Licence: CA A44995) | |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2014-09-18 |