| NPI | 1447271879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OR MD28896) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: VT 0472) |
| 207ND0900X Dermatology, Dermatopathology (Licence: VT 0472) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: OR MD28896) | |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2009-01-29 |