| NPI | 1750791349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: MD D89342) |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory (Licence: MD D89342) |
| Enumeration Date | 2014-05-05 |
| Last Update Date | 2026-03-16 |