| NPI | 1942298161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD00040702) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL ME72344) |
| 207ND0900X Dermatology, Dermatopathology (Licence: WA MD00040702) | |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2022-06-13 |