| NPI | 1619294337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: UT 8963761-1204) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: UT 8963761-1204) |
| Enumeration Date | 2010-04-21 |
| Last Update Date | 2016-03-07 |