| NPI | 1881964864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: FL ME 17953) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: FL ME 17953) |
| Enumeration Date | 2012-01-06 |
| Last Update Date | 2012-01-06 |