| NPI | 1952960411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CO 0074480) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MA 1017036) |
| 207N00000X Dermatology (Licence: MN 67652) | |
| 207R00000X Internal Medicine (Licence: PA MT218467) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MN 67652) | |
| Enumeration Date | 2019-06-10 |
| Last Update Date | 2025-11-17 |