| NPI | 1104156033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: NM 74-29) |
| Additional Taxonomies | 207ND0900X Dermatology Dermatopathology (Licence: NM 74-29) |
| Enumeration Date | 2009-12-24 |
| Last Update Date | 2009-12-24 |