| NPI | 1578530663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX D4371) |
| Additional Taxonomies | 207NI0002X Dermatology, Clinical & Laboratory Dermatological Immunology (Licence: TX d4371) |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: TX d4371) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: TX d4371) | |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2007-07-08 |