| NPI | 1861495012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TN 35668) |
| Additional Taxonomies | 207NP0225X Dermatology Pediatric Dermatology (Licence: TN 35668) |
| 207NS0135X Dermatology Procedural Dermatology (Licence: TN 35668) | |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2007-07-08 |