| NPI | 1790818201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZD0900X Pathology, Dermatopathology (Licence: CA G67496) |
| Additional Taxonomies | 246QM0900X Spec/Tech, Pathology, Microbiology (Licence: TX N2082) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2017-10-04 |