| NPI | 1245220698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207ZD0900X Pathology Dermatopathology (Licence: FL ME87314) |
| Additional Taxonomies | 207NS0135X Dermatology Procedural Dermatology (Licence: FL ME87314) |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2007-07-08 |