| NPI | 1902198518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: MN 59565) |
| Additional Taxonomies | 207ZD0900X Pathology, Dermatopathology (Licence: MN 59565) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MN 59565) | |
| 207ZP0105X Pathology, Clinical Pathology/Laboratory Medicine (Licence: MN 59565) | |
| Enumeration Date | 2011-05-15 |
| Last Update Date | 2019-01-18 |