| NPI | 1386619203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: KY 50543) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: KY 40543) |
| 207ND0900X Dermatology, Dermatopathology (Licence: AR E0888) | |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2025-10-28 |