| NPI | 1407086424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: MI 4301108678) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MI 4301108678) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MI 4301108678) | |
| 208D00000X General Practice (Licence: MI 4301108678) | |
| Enumeration Date | 2009-07-24 |
| Last Update Date | 2022-01-04 |