| NPI | 1548365950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA G10697) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: CA G10697) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2010-09-15 |