| NPI | 1790780088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 27302) |
| Additional Taxonomies | 174400000X Specialist (Licence: NC 27302) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: NC 27302) | |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2007-09-08 |