| NPI | 1710334420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: CT 65128) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CT 65128) |
| Enumeration Date | 2016-05-23 |
| Last Update Date | 2024-06-20 |