| NPI | 1093713067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WY 2634A) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: WY 2634A) |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2014-07-29 |