| NPI | 1699761528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: VT 0420005614) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: MA 43419) |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2007-07-08 |