| NPI | 1770578924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NM 20020450) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: NM 20020450) |
| 207ZD0900X Pathology, Dermatopathology (Licence: NM MD2002-0450) | |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2014-05-22 |