| NPI | 1104096544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZD0900X Pathology, Dermatopathology (Licence: AL 32386) |
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: AL 32386) |
| 207Q00000X Family Medicine (Licence: AL 32386) | |
| Enumeration Date | 2008-02-29 |
| Last Update Date | 2013-05-17 |