| NPI | 1245454149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZD0900X Pathology Dermatopathology (Licence: TN MD44945) |
| Additional Taxonomies | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: GA 060336) |
| 207ZD0900X Pathology Dermatopathology (Licence: TX BP10031728) | |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2020-06-02 |