| NPI | 1114917366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: KS 04-30166) |
| Additional Taxonomies | 207ZD0900X Pathology, Dermatopathology (Licence: KS 04-30166) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MO 2003008002) | |
| 207ZD0900X Pathology, Dermatopathology (Licence: CO 36889) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: CO 36889) | |
| 207ZD0900X Pathology, Dermatopathology (Licence: MO 2003008002) | |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2026-05-14 |