| NPI | 1598898967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MS 20291) |
| Additional Taxonomies | 207ZD0900X Pathology, Dermatopathology (Licence: MS 20291) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: FL ME89484) | |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2021-12-13 |