| NPI | 1912008707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZD0900X Pathology, Dermatopathology (Licence: MI 4301042507) |
| Additional Taxonomies | 174400000X Specialist (Licence: MI 4301042507) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2015-01-12 |