| NPI | 1417908484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207ZD0900X Pathology Dermatopathology (Licence: GA 010965) |
| Additional Taxonomies | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: GA 010965) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2007-07-08 |