| NPI | 1679968150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0900X Dermatology Dermatopathology (Licence: MI 5101025453) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MI 5101025453) |
| 207ZC0006X Pathology Clinical Pathology (Licence: MI 5101025453) | |
| Enumeration Date | 2015-04-01 |
| Last Update Date | 2020-12-15 |