| NPI | 1255324703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MO 109839) |
| Additional Taxonomies | 207ND0900X Dermatology Dermatopathology (Licence: MO 109839) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2012-04-03 |