| NPI | 1811981368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: GA 013257) |
| Additional Taxonomies | 207NP0225X Dermatology Pediatric Dermatology (Licence: GA 013257) |
| 207NS0135X Dermatology Procedural Dermatology (Licence: GA 013257) | |
| 208D00000X General Practice (Licence: GA 013257) | |
| 207ND0900X Dermatology Dermatopathology (Licence: GA 013257) | |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2015-04-22 |