| NPI | 1508861634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA G42744) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: CA G42744) |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2007-07-09 |