| NPI | 1063948487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: OR MD215961) |
| Additional Taxonomies | 207ZD0900X Pathology, Dermatopathology (Licence: AL 52535) |
| Enumeration Date | 2017-05-04 |
| Last Update Date | 2025-10-31 |