| NPI | 1902074628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZD0900X Pathology, Dermatopathology (Licence: FL ME0057323) |
| Additional Taxonomies | 207ZP0101X Pathology, Anatomic Pathology (Licence: FL ME0057323) |
| Enumeration Date | 2008-02-15 |
| Last Update Date | 2015-01-14 |