| NPI | 1104893569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: WA MD00018776) |
| Additional Taxonomies | 207ZD0900X Pathology Dermatopathology (Licence: WA MD00018776) |
| Enumeration Date | 2006-03-03 |
| Last Update Date | 2008-01-02 |