| NPI | 1639390321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 2010-00859) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: SC 30683) |
| 207ND0900X Dermatology, Dermatopathology (Licence: SC 30683) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: NC 2010-00859) | |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2019-09-03 |