| NPI | 1528453057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: TX S0672) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX S0672) |
| Enumeration Date | 2015-04-01 |
| Last Update Date | 2024-11-14 |