| NPI | 1053547075 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207ZP0105X Pathology, Clinical Pathology/Laboratory Medicine (Licence: CA A103834)  | 
| Additional Taxonomies | 207ZD0900X Pathology, Dermatopathology (Licence: CA A103834)  | 
| Enumeration Date | 2009-06-04 | 
| Last Update Date | 2021-11-03 |