| NPI | 1518134154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: CA A118101) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX R0862) |
| Enumeration Date | 2008-05-13 |
| Last Update Date | 2026-06-11 |