| NPI | 1003884339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OK 9074) |
| Additional Taxonomies | 207ND0900X Dermatology Dermatopathology (Licence: OK 9074) |
| Enumeration Date | 2006-03-11 |
| Last Update Date | 2015-04-23 |