| NPI | 1174584403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: TN 40852) |
| Additional Taxonomies | 207ZD0900X Pathology, Dermatopathology (Licence: TN 40852) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: SC 23866) | |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2021-05-18 |