| NPI | 1386612547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0101237413) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: VA 0101237413) |
| 207NI0002X Dermatology, Clinical & Laboratory Dermatological Immunology (Licence: VA 0101237413) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: VA 0101237413) | |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2022-04-13 |