| NPI | 1770571424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MI 4301029683) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: MI 4301029683) |
| 207NI0002X Dermatology, Clinical & Laboratory Dermatological Immunology (Licence: MI 4301029683) | |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: MI 4301029683) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: MI 4301029683) | |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2008-02-28 |