| NPI | 1568783819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: UT 13269871-1205) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: UT 13269871-1205) |
| 207N00000X Dermatology (Licence: AZ 50147) | |
| 207N00000X Dermatology (Licence: AZ 050147) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: AZ 050147) | |
| Enumeration Date | 2010-06-21 |
| Last Update Date | 2023-08-03 |