| NPI | 1861495046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: KY 32539) |
| Additional Taxonomies | 207ZD0900X Pathology, Dermatopathology (Licence: KY 32539) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: KY 32539) | |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2021-02-19 |