| NPI | 1386611390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: WA MD) |
| Additional Taxonomies | 207ZD0900X Pathology Dermatopathology (Licence: WA MD00026854) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2008-07-28 |