| NPI | 1245211770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZD0900X Pathology Dermatopathology (Licence: OH 35.076407) |
| Additional Taxonomies | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: OH 35.076407) |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2023-01-17 |