| NPI | 1841277142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: MN 26233) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: AZ 17745) |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2023-01-19 |