| NPI | 1811335896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: VA 0101258193) |
| Additional Taxonomies | 207ZD0900X Pathology Dermatopathology (Licence: VA 0101258193) |
| Enumeration Date | 2013-06-12 |
| Last Update Date | 2025-06-17 |