| NPI | 1417181819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OR 198045) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: OR 198045) |
| Enumeration Date | 2009-05-13 |
| Last Update Date | 2024-07-24 |