| NPI | 1851395529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: UT 174191-1205) |
| Additional Taxonomies | 207NI0002X Dermatology Clinical & Laboratory Dermatological Immunology (Licence: UT 174191-1205) |
| 207NS0135X Dermatology Procedural Dermatology (Licence: UT 174191-1205) | |
| 207ND0900X Dermatology Dermatopathology (Licence: UT 174191-1205) | |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2007-07-08 |