| NPI | 1770996621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: SC 36991) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: SC 36991) |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2020-08-03 |