| NPI | 1306183058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 2023-02112) |
| Additional Taxonomies | 207ZD0900X Pathology, Dermatopathology (Licence: NC 2023-02112) |
| 208D00000X General Practice (Licence: VA 0101256702) | |
| Enumeration Date | 2013-01-14 |
| Last Update Date | 2024-06-17 |