| NPI | 1417918509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZD0900X Pathology Dermatopathology (Licence: MI 5101015559) |
| Additional Taxonomies | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: MI 5101015559) |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: OH 34007667) | |
| 207ZD0900X Pathology Dermatopathology (Licence: OH 34007667) | |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2013-11-13 |