| NPI | 1548255482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA G85304) |
| Additional Taxonomies | 207NP0225X Dermatology, Pediatric Dermatology (Licence: CA G85304) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: CA G85304) | |
| Enumeration Date | 2005-09-16 |
| Last Update Date | 2017-03-28 |