| NPI | 1629032271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA G57056) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: CA G57056) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: CA G57056) | |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2020-05-28 |