| NPI | 1902895832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZD0900X Pathology, Dermatopathology (Licence: FL ME34694) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: FL ME34694) |
| 207ND0900X Dermatology, Dermatopathology (Licence: OH 35.037604) | |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2016-06-13 |