| NPI | 1346230786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: FL ME71993) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: FL ME71993) |
| 207ND0900X Dermatology, Dermatopathology (Licence: CA A69617) | |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: FL ME71993) | |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: CA A69617) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: CA A69617) | |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2010-02-12 |