| NPI | 1174620496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: NV 17674) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: FL ME97172) |
| 207ND0900X Dermatology, Dermatopathology (Licence: OH 35.088653) | |
| 207ZD0900X Pathology, Dermatopathology (Licence: TX T4386) | |
| 207N00000X Dermatology (Licence: FL ME97172) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2021-12-20 |