| NPI | 1659494326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: GA 070168) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207ND0900X Dermatology, Dermatopathology (Licence: GA 070168) | |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2013-07-08 |