| NPI | 1285610014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZD0900X Pathology Dermatopathology (Licence: MA 158848) |
| Additional Taxonomies | 207ZP0101X Pathology Anatomic Pathology (Licence: MA 158848) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2011-11-16 |