| NPI | 1407851363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OR MD24345) |
| Additional Taxonomies | 207NI0002X Dermatology, Clinical & Laboratory Dermatological Immunology (Licence: OR MD24345) |
| 207NI0002X Dermatology, Clinical & Laboratory Dermatological Immunology (Licence: WA MD00041910) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: OR MD24345) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: WA MD00041910) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: OR MD24345) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: WA MD00041910) | |
| 207N00000X Dermatology (Licence: WA MD00041910) | |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2008-09-08 |