| NPI | 1831181304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: WV 15226) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 15226) |
| Enumeration Date | 2005-08-19 |
| Last Update Date | 2007-07-08 |