| NPI | 1669464285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX E3304) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: TX 207N10002X) |
| 207NI0002X Dermatology, Clinical & Laboratory Dermatological Immunology (Licence: TX E3304) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: TX E3304) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: TX E3304) | |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: TX E3304) | |
| Enumeration Date | 2005-08-19 |
| Last Update Date | 2007-12-28 |