| NPI | 1679577100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 200100465) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: NC 200100465) |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2025-06-03 |