| NPI | 1518254481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A123273) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: CA A123273) |
| Enumeration Date | 2011-06-29 |
| Last Update Date | 2022-07-21 |