| NPI | 1003040403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: NY 263239) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX Q3555) |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: TX Q3555) | |
| Enumeration Date | 2009-05-13 |
| Last Update Date | 2021-01-11 |