| NPI | 1053547885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: MI 4301100629) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: GA 74802) |
| Enumeration Date | 2009-06-08 |
| Last Update Date | 2018-10-18 |