| NPI | 1083694418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0101X Pathology Anatomic Pathology (Licence: TX L0403) |
| Additional Taxonomies | 207ZP0213X Pathology Pediatric Pathology (Licence: TX L0403) |
| 207ZD0900X Pathology Dermatopathology (Licence: TX L0403) | |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2023-04-19 |