| NPI | 1609837566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: WA MD60067502) |
| Additional Taxonomies | 207ZD0900X Pathology, Dermatopathology (Licence: NV 9012) |
| 207ZD0900X Pathology, Dermatopathology (Licence: AZ 33264) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NV 9012) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: AZ 33264) | |
| Enumeration Date | 2006-03-30 |
| Last Update Date | 2015-02-04 |