| NPI | 1619969136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZD0900X Pathology, Dermatopathology (Licence: LA MD014667) |
| Additional Taxonomies | 207ZD0900X Pathology, Dermatopathology (Licence: LA L014667) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: LA L014667) | |
| Enumeration Date | 2005-08-19 |
| Last Update Date | 2015-02-25 |