| NPI | 1487098059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0900X Dermatology Dermatopathology (Licence: FL OS14613) |
| Additional Taxonomies | 207ZD0900X Pathology Dermatopathology (Licence: FL OS14613) |
| 207ZP0101X Pathology Anatomic Pathology (Licence: FL OS14613) | |
| Enumeration Date | 2013-04-25 |
| Last Update Date | 2019-07-03 |