| NPI | 1992748594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME170186) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WI 48484020) |
| 207ND0900X Dermatology, Dermatopathology (Licence: WI 48484020) | |
| 207N00000X Dermatology (Licence: MN 41575) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: MN 41575) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: CO 476883) | |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2024-11-26 |