| NPI | 1285632422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OK 12875) |
| Additional Taxonomies | 207NI0002X Dermatology, Clinical & Laboratory Dermatological Immunology (Licence: OK 12875) |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: OK 12875) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: OK 12875) | |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2009-10-05 |