| NPI | 1629344189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0900X Dermatology Dermatopathology (Licence: MI 4301114577) |
| Additional Taxonomies | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: IL 125062313) |
| Enumeration Date | 2012-03-29 |
| Last Update Date | 2021-04-26 |