| NPI | 1558789560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD61334955) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: ID M-14612) |
| 207ND0900X Dermatology, Dermatopathology (Licence: WA MD61334955) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: ID M-14612) | |
| Enumeration Date | 2014-04-07 |
| Last Update Date | 2023-04-12 |