| NPI | 1649493123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: TN MD0000048564) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TN 48564) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2019-02-01 |