| NPI | 1578626677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0900X Dermatology Dermatopathology (Licence: FL ME130462) |
| Additional Taxonomies | 207ZD0900X Pathology Dermatopathology (Licence: MO 2013013692) |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: MO 2013013692) | |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2018-01-16 |