| NPI | 1063547503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: SC 14814) |
| Additional Taxonomies | 207ZD0900X Pathology, Dermatopathology (Licence: GA 052853) |
| 207ZD0900X Pathology, Dermatopathology (Licence: SC 14814) | |
| 207ZD0900X Pathology, Dermatopathology (Licence: FL 103481) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: GA 052853) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: FL 103481) | |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2009-10-20 |