| NPI | 1619255502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MA 248412) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: MA 248412) |
| Enumeration Date | 2011-07-27 |
| Last Update Date | 2016-04-13 |