| NPI | 1164447215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: CT 041939) |
| Additional Taxonomies | 207ZD0900X Pathology, Dermatopathology (Licence: CT 041939) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2013-11-26 |