| NPI | 1811377286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: TX S7026) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: TX S7026) |
| 207N00000X Dermatology (Licence: TX S7026) | |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2026-01-14 |