| NPI | 1356331508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WV 10775) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: WV 10775) |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2022-01-25 |