| NPI | 1942513924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: OR MD170132) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: WA MD60773242) |
| Enumeration Date | 2010-07-20 |
| Last Update Date | 2019-01-01 |