| NPI | 1992912968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MO 2012013482) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A111360) |
| 207ND0900X Dermatology, Dermatopathology (Licence: CA A111360) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: MO 2012013482) | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2012-07-06 |