| NPI | 1720042153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: CO 41239) |
| Additional Taxonomies | 207ZD0900X Pathology Dermatopathology (Licence: CO 41239) |
| 207ZD0900X Pathology Dermatopathology (Licence: TX K9920) | |
| 207ZD0900X Pathology Dermatopathology (Licence: HI MD9167) | |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: TX K9920) | |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: HI MD9167) | |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2007-12-17 |