| NPI | 1326272089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: CA A131200) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA 131200) |
| 207ND0900X Dermatology, Dermatopathology (Licence: CA A131200) | |
| Enumeration Date | 2009-05-11 |
| Last Update Date | 2024-03-14 |