| NPI | 1871574814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: IA 36288) |
| Additional Taxonomies | 207ZD0900X Pathology Dermatopathology (Licence: IA 36288) |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2007-12-12 |