| NPI | 1417932716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A31930) |
| Additional Taxonomies | 207ZD0900X Pathology, Dermatopathology (Licence: CA 0500687140) |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2011-01-10 |