| NPI | 1962848671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: GA 85044) |
| Additional Taxonomies | 207ZD0900X Pathology, Dermatopathology (Licence: GA 85044) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: TN 61567) | |
| 207ZD0900X Pathology, Dermatopathology (Licence: MN 59596) | |
| Enumeration Date | 2013-05-21 |
| Last Update Date | 2023-01-17 |