| NPI | 1104311596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: SC LL52671) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: ID 9971137) |
| 207N00000X Dermatology (Licence: ID 9971137) | |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2025-09-09 |