| NPI | 1316915267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A21656) |
| Additional Taxonomies | 207ND0900X Dermatology Dermatopathology (Licence: CA A21656) |
| 207NS0135X Dermatology Procedural Dermatology (Licence: CA A21656) | |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2010-06-10 |