| NPI | 1508863150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: CA A23310) |
| Additional Taxonomies | 207NI0002X Dermatology, Clinical & Laboratory Dermatological Immunology (Licence: CA A23310) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: CA A23310) | |
| Enumeration Date | 2005-06-28 |
| Last Update Date | 2025-09-11 |