| NPI | 1295785525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NE 1038) |
| Additional Taxonomies | 207NP0225X Dermatology, Pediatric Dermatology (Licence: NE 1038) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: NE 1038) | |
| 363AS0400X Physician Assistant, Surgical (Licence: NE 1038) | |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2021-03-16 |