| NPI | 1902870892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZD0900X Pathology, Dermatopathology (Licence: CA 20A9298) |
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: CA 20A9298) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2019-10-15 |