| NPI | 1932215506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MO 2009006327) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: KS 04-31955) |
| 207ND0900X Dermatology Dermatopathology (Licence: MO 2009006327) | |
| 207ND0900X Dermatology Dermatopathology (Licence: KS 04-31955) | |
| 207ND0900X Dermatology Dermatopathology (Licence: TX N8251) | |
| 207ND0900X Dermatology Dermatopathology (Licence: CA C55335) | |
| 207N00000X Dermatology (Licence: TX N8251) | |
| 207N00000X Dermatology (Licence: CA C55335) | |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2015-10-02 |