| NPI | 1780681122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: CT 038784) |
| Additional Taxonomies | 207ZP0101X Pathology, Anatomic Pathology (Licence: CT 038784) |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2022-09-30 |