| NPI | 1558364976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0900X Dermatology Dermatopathology (Licence: KY 31195) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: KY 31195) |
| 207NI0002X Dermatology Clinical & Laboratory Dermatological Immunology (Licence: KY 31195) | |
| 207NS0135X Dermatology Procedural Dermatology (Licence: KY 31195) | |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2023-10-06 |