| NPI | 1801177522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZD0900X Pathology, Dermatopathology (Licence: CO CDRH.0065436) |
| Additional Taxonomies | 207ZD0900X Pathology, Dermatopathology (Licence: MI 5011028925) |
| 207ZD0900X Pathology, Dermatopathology (Licence: OR DO224086) | |
| Enumeration Date | 2011-09-08 |
| Last Update Date | 2026-09-11 |