| NPI | 1972570372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZD0900X Pathology Dermatopathology (Licence: SC 8871) |
| Additional Taxonomies | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: SC 8871) |
| Enumeration Date | 2006-03-03 |
| Last Update Date | 2009-08-25 |