| NPI | 1982663944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WI 42954) |
| Additional Taxonomies | 207ND0900X Dermatology Dermatopathology (Licence: WI 42954) |
| Enumeration Date | 2006-03-20 |
| Last Update Date | 2021-01-14 |