| NPI | 1619394780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 320246) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WA MD60949822) |
| 207ND0900X Dermatology, Dermatopathology (Licence: NY 320246) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: WA MD60949822) | |
| Enumeration Date | 2014-03-26 |
| Last Update Date | 2023-04-25 |