| NPI | 1316259435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0900X Dermatology Dermatopathology (Licence: WV 28520) |
| Additional Taxonomies | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: MA 258041) |
| Enumeration Date | 2010-07-06 |
| Last Update Date | 2018-11-28 |