| NPI | 1407854490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: PA MD043706L) |
| Additional Taxonomies | 207ZD0900X Pathology, Dermatopathology (Licence: PA MD043706L) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: PA MD043706L) | |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2014-10-10 |