| NPI | 1851824825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX T4259) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NM MD2022-0156) |
| 207ND0900X Dermatology, Dermatopathology (Licence: NM MD2022-0156) | |
| Enumeration Date | 2017-04-06 |
| Last Update Date | 2026-07-06 |