| NPI | 1720063662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: PA MD043524E) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: PA MD043524E) |
| 207N00000X Dermatology (Licence: TX G6401) | |
| 207N00000X Dermatology (Licence: CA G61072) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: CA G61072) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: TX G6401) | |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2013-12-23 |