| NPI | 1265827893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: UT 12888572-1235) |
| Additional Taxonomies | 207ZD0900X Pathology, Dermatopathology (Licence: AZ 67275) |
| Enumeration Date | 2015-03-31 |
| Last Update Date | 2024-01-17 |