| NPI | 1245771575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0900X Dermatology Dermatopathology (Licence: TX BP10071471) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA 157250) |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2023-05-02 |