| NPI | 1033503164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 2020-01159) |
| Additional Taxonomies | 207ZD0900X Pathology, Dermatopathology (Licence: NC 2020-01159) |
| 207N00000X Dermatology (Licence: VA 0101267259) | |
| Enumeration Date | 2015-03-26 |
| Last Update Date | 2026-03-22 |