| NPI | 1023020120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: WI WI16879) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WI WI16879) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2010-09-22 |