| NPI | 1639563547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: ID M-15342) |
| Additional Taxonomies | 207ZD0900X Pathology Dermatopathology (Licence: ID M-15342) |
| Enumeration Date | 2015-03-28 |
| Last Update Date | 2023-10-19 |