| NPI | 1861538480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0900X Dermatology Dermatopathology (Licence: WA MD00039423) |
| Additional Taxonomies | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: WA MD00039423) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2007-12-12 |