| NPI | 1518126218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL me93288) |
| Additional Taxonomies | 208D00000X General Practice (Licence: GA 070481) |
| 207ND0900X Dermatology, Dermatopathology (Licence: GA 070481) | |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: GA 070481) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: GA 070481) | |
| Enumeration Date | 2008-06-06 |
| Last Update Date | 2023-11-27 |