| NPI | 1306997804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: TN 68529) |
| Additional Taxonomies | 207ZD0900X Pathology, Dermatopathology (Licence: TN 68529) |
| Enumeration Date | 2007-01-13 |
| Last Update Date | 2023-08-20 |