| NPI | 1811942840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: IA 35180) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NE 23635) |
| 207N00000X Dermatology (Licence: CO 43457) | |
| 207ND0900X Dermatology Dermatopathology (Licence: NE 23635) | |
| 207ND0900X Dermatology Dermatopathology (Licence: IA 35180) | |
| 207NI0002X Dermatology Clinical & Laboratory Dermatological Immunology (Licence: IA 35180) | |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2008-05-07 |