| NPI | 1871694315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA G40607) |
| Additional Taxonomies | 207ND0900X Dermatology Dermatopathology (Licence: CA G40607) |
| 207NS0135X Dermatology Procedural Dermatology (Licence: CA G40607) | |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2013-03-21 |