| NPI | 1083644264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: FL ME104580) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: TN 0000044637) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NC 200801640) | |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2020-09-11 |