| NPI | 1710075858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA C25642) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: CA C25642) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2014-02-28 |