| NPI | 1083853006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MA 221105) |
| Additional Taxonomies | 207ZD0900X Pathology, Dermatopathology (Licence: TN 44583) |
| Enumeration Date | 2009-02-14 |
| Last Update Date | 2020-06-02 |