| NPI | 1750515565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: CT 061363) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WA MD60454651) |
| 207ND0900X Dermatology, Dermatopathology (Licence: WA MD60454651) | |
| Enumeration Date | 2009-05-07 |
| Last Update Date | 2024-08-23 |