| NPI | 1003342833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX S9489) |
| Additional Taxonomies | 207ND0900X Dermatology Dermatopathology (Licence: TX S9489) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2023-06-06 |