| NPI | 1730181017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: TX J9557) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX J9557) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2021-12-02 |