| NPI | 1982696639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CO 22263) |
| Additional Taxonomies | 207ND0900X Dermatology Dermatopathology (Licence: CO 22263) |
| 207NS0135X Dermatology Procedural Dermatology (Licence: CO 22263) | |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2014-03-05 |