| NPI | 1508999152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OR MD21432) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: OR MD21432) |
| 207ND0900X Dermatology, Dermatopathology (Licence: OR MD21432) | |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2008-02-27 |