| NPI | 1922461235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZD0900X Pathology, Dermatopathology (Licence: MI 4301501739) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OH 35.139934) |
| 207N00000X Dermatology (Licence: MI 4301501739) | |
| 207ZD0900X Pathology, Dermatopathology (Licence: OR MD203405) | |
| Enumeration Date | 2016-04-04 |
| Last Update Date | 2024-01-23 |