| NPI | 1740287960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA a20602) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: CA A20602) |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2011-09-15 |