| NPI | 1497956569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: FL ME106515) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL ME106515) |
| 207ND0900X Dermatology, Dermatopathology (Licence: NC 2020-04673) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: TX N0402) | |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2024-07-19 |