| NPI | 1902835689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MD D44137) |
| Additional Taxonomies | 207ND0900X Dermatology Dermatopathology (Licence: MD D44137) |
| 207NS0135X Dermatology Procedural Dermatology (Licence: MD D44137) | |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2011-03-16 |