| NPI | 1891801346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: UT 158613-1205) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: UT 158613-8905) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2007-08-17 |