| NPI | 1053313411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD.MD.00015691) |
| Additional Taxonomies | 207ZD0900X Pathology, Dermatopathology (Licence: WA MD.MD.00015691) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2026-08-04 |