| NPI | 1124061619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: WI 74455-20) |
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: WA MD00034088) |
| 207ZD0900X Pathology, Dermatopathology (Licence: WI 74455-20) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: FL ME122758) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: OR MD21809) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: WI 74455-20) | |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2023-02-13 |