| NPI | 1164782454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: WA MD61464042) |
| Additional Taxonomies | 207ZD0900X Pathology, Dermatopathology (Licence: NJ S-17-193) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NJ 25MA10480400) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: AZ 61563) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NJ 16-120) | |
| Enumeration Date | 2012-05-21 |
| Last Update Date | 2023-11-22 |