| NPI | 1922032077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA G46342) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: CA G46242) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: CA g46342) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2008-06-17 |