| NPI | 1376526095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0900X Dermatology Dermatopathology (Licence: WI 53576-020) |
| Additional Taxonomies | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: WI 53576-20) |
| 207ND0900X Dermatology Dermatopathology (Licence: MI 4301085258) | |
| 207ZD0900X Pathology Dermatopathology (Licence: WI 53576-20) | |
| 207N00000X Dermatology (Licence: WI 53576-20) | |
| Enumeration Date | 2005-11-28 |
| Last Update Date | 2024-11-25 |