| NPI | 1508854902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: PA MD043392L) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: PA MD043392L) |
| Enumeration Date | 2005-10-10 |
| Last Update Date | 2014-04-30 |