| NPI | 1326166521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207NI0002X Dermatology Clinical & Laboratory Dermatological Immunology (Licence: CA A43801) |
| Additional Taxonomies | 207ND0900X Dermatology Dermatopathology (Licence: CA A43801) |
| 207NS0135X Dermatology Procedural Dermatology (Licence: CA A43801) | |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2024-04-15 |