| NPI | 1861496648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: VA 0101232830) |
| Additional Taxonomies | 207ZD0900X Pathology Dermatopathology (Licence: AL 18786) |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: AL 18786) | |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: TN 20922) | |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2016-05-19 |