| NPI | 1588662019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MA 223863) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: MA 223863) |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2007-11-08 |