| NPI | 1134104029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: PA MD037056E) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: PA MD037056E) |
| 207ZP0101X Pathology, Anatomic Pathology (Licence: PA MD037056E) | |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2015-06-18 |