| NPI | 1790776227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207ZD0900X Pathology Dermatopathology (Licence: MA 32178) |
| Additional Taxonomies | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: MA 32178) |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2007-07-08 |