| NPI | 1376541995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OR MD11864) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: OR MD11864) |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2009-08-07 |