| NPI | 1962473199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0101055577) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: VA 0101055577) |
| 207ND0900X Dermatology, Dermatopathology (Licence: VA 0101055577) | |
| 207N00000X Dermatology (Licence: WV 18997) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: WV 18997) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: WV 18997) | |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2008-05-21 |