| NPI | 1255395539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MD D28241) |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory (Licence: MD D28241) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2025-12-09 |