| NPI | 1811379274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NM MD2024-0810) |
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NM MD2024-0810) |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2025-01-22 |