| NPI | 1366443210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZD0900X Pathology, Dermatopathology (Licence: MS 06914) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MS 06914) |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2007-07-08 |