| NPI | 1982602025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: OK 18408) |
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: OK 18048) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2022-09-22 |