| NPI | 1376542340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A26516) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: CA A26516) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: CA A26516) | |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2017-04-28 |