| NPI | 1437186228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: LA 015298) |
| Additional Taxonomies | 207NP0225X Dermatology, Pediatric Dermatology (Licence: LA 015298) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: LA 015298) | |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2010-02-09 |