| NPI | 1841261286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: UT 4837679-1205) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MN 47975) |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2020-11-09 |