| NPI | 1518311778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0900X Dermatology Dermatopathology (Licence: TX T9810) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: AR E-13464) |
| 207N00000X Dermatology (Licence: TX T9810) | |
| 207N00000X Dermatology (Licence: PA MT210376) | |
| Enumeration Date | 2016-04-14 |
| Last Update Date | 2024-10-09 |