| NPI | 1205331832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: MN 65849) |
| Additional Taxonomies | 207ZP0105X Pathology, Clinical Pathology/Laboratory Medicine (Licence: MN 29150) |
| 207ZP0101X Pathology, Anatomic Pathology (Licence: MN 65849) | |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2024-01-09 |