| NPI | 1023080561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: GA 65639) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: GA 65638) |
| 207N00000X Dermatology (Licence: PA MD439815) | |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2014-12-10 |