| NPI | 1700844099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: NE 21483) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NE 21483) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2011-06-24 |