| NPI | 1073508750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: NE 15625) |
| Additional Taxonomies | 207ND0900X Dermatology Dermatopathology (Licence: NE 15625) |
| 207NS0135X Dermatology Procedural Dermatology (Licence: NE 15625) | |
| 2083P0901X Preventive Medicine Public Health & General Preventive Medicine (Licence: NE 15625) | |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2023-04-14 |