| NPI | 1760812523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: MI 4301114054) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: MI 4301114054) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MA 255400) | |
| Enumeration Date | 2013-11-14 |
| Last Update Date | 2018-12-05 |