| NPI | 1952472292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: UT 161345-1205) |
| Additional Taxonomies | 207ND0900X Dermatology Dermatopathology (Licence: UT 161345-1205) |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2021-11-08 |