| NPI | 1700900263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: GA 67728) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: MN 45466) |
| 207ND0900X Dermatology, Dermatopathology (Licence: FL ME 99524) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: NY 246512-1) | |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2012-11-27 |