| NPI | 1851563779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: UT 7890794-1205) |
| Additional Taxonomies | 207NS0135X Dermatology Procedural Dermatology (Licence: UT 7890794-1205) |
| 207ND0900X Dermatology Dermatopathology (Licence: UT 7890794.1205) | |
| Enumeration Date | 2008-04-01 |
| Last Update Date | 2019-09-13 |