| NPI | 1790751410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: FL ME99216) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL ME99216) |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2026-03-18 |