| NPI | 1154320232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CT 43924) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: NY 179433-1) |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2012-03-01 |