| NPI | 1306846746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CO 26193) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: CO 26193) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: CO 26193) | |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2015-10-20 |