| NPI | 1487610721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MI 4301061025) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: MI ER061025) |
| 207NI0002X Dermatology, Clinical & Laboratory Dermatological Immunology (Licence: MI ER061025) | |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2011-03-07 |