| NPI | 1679573331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0900X Dermatology Dermatopathology (Licence: MI 4301030349) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MI 4301030349) |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2014-01-22 |