| NPI | 1891748117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: ID M5900) |
| Additional Taxonomies | 207ND0900X Dermatology Dermatopathology (Licence: ID M5900) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2013-09-24 |