| NPI | 1568420602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: OH 35078311) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: WV 27771) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2018-07-10 |