| NPI | 1811988736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 2007-01039) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA 060064) |
| 207N00000X Dermatology (Licence: GA 060064) | |
| 207NP0225X Dermatology Pediatric Dermatology (Licence: GA 060064) | |
| 207NS0135X Dermatology Procedural Dermatology (Licence: GA 060064) | |
| 208D00000X General Practice (Licence: GA 060064) | |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2022-06-16 |