| NPI | 1366556193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX G4701) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: TX G4701) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2022-03-22 |