| NPI | 1912125204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: TN 44888) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TN 44888) |
| 207N00000X Dermatology (Licence: SC 32355) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: OH 35137423) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: TN 44888) | |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2021-05-19 |