| NPI | 1104804038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA C208136) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: CA C208136) |
| 207N00000X Dermatology (Licence: WI 51390-020) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: WI 51390-020) | |
| 207N00000X Dermatology (Licence: MN 47142) | |
| 207ZD0900X Pathology, Dermatopathology (Licence: WI 51390-20) | |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2026-09-01 |