| NPI | 1932133030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NH 14454) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: GA G16239) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: GA GA16239) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: NH 14454) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2012-12-05 |