| NPI | 1699234583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: KY TP695) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WV 33819) |
| 207ND0900X Dermatology, Dermatopathology (Licence: WV 33819) | |
| Enumeration Date | 2019-03-19 |
| Last Update Date | 2025-10-29 |