| NPI | 1861499147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 175720) |
| Additional Taxonomies | 207ZD0900X Pathology, Dermatopathology (Licence: NY 175720) |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2009-07-10 |