| NPI | 1720669351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX W0222) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: TX W0222) |
| Enumeration Date | 2021-04-15 |
| Last Update Date | 2026-07-22 |