| NPI | 1629050752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AL 7094) |
| Additional Taxonomies | 207NP0225X Dermatology, Pediatric Dermatology (Licence: AL 7094) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: AL 7094) | |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2013-08-21 |