| NPI | 1770745978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MN 57834) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: MN 57834) |
| Enumeration Date | 2008-06-28 |
| Last Update Date | 2020-06-16 |