| NPI | 1861482465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TN 38003) |
| Additional Taxonomies | 207ND0900X Dermatology Dermatopathology (Licence: TN 38003) |
| 207NS0135X Dermatology Procedural Dermatology (Licence: TN 38003) | |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2009-06-01 |