| NPI | 1962451146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ 23211) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: AZ 23211) |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2012-10-29 |