| NPI | 1083676829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: TX H5825) |
| Additional Taxonomies | 207ZC0500X Pathology Cytopathology (Licence: TX H5825) |
| 207ZD0900X Pathology Dermatopathology (Licence: TX H5825) | |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2007-12-05 |