| NPI | 1780616821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZD0900X Pathology, Dermatopathology (Licence: AZ 66352) |
| Additional Taxonomies | 207ZD0900X Pathology, Dermatopathology (Licence: MN 55602) |
| 207ZP0101X Pathology, Anatomic Pathology (Licence: MN 55602) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2022-08-12 |