| NPI | 1609169267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZD0900X Pathology Dermatopathology (Licence: AZ 54161) |
| Additional Taxonomies | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: AZ 54161) |
| Enumeration Date | 2011-05-16 |
| Last Update Date | 2017-04-13 |