| NPI | 1891951091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: UT 287202-1205) |
| Additional Taxonomies | 207ZD0900X Pathology, Dermatopathology (Licence: UT 287202-1205) |
| 207ZD0900X Pathology, Dermatopathology (Licence: PA MD430434) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: PA MD430434) | |
| Enumeration Date | 2008-08-06 |
| Last Update Date | 2009-08-25 |