| NPI | 1609863612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: TX N2463) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD419328) |
| 207ZD0900X Pathology Dermatopathology (Licence: TX N2463) | |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: FL ME98122) | |
| 208D00000X General Practice (Licence: TX N2463) | |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2023-02-14 |