| NPI | 1982716452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: OK 7103) |
| Additional Taxonomies | 207ZD0900X Pathology Dermatopathology (Licence: OK 7103) |
| 207ZD0900X Pathology Dermatopathology (Licence: AZ 30974) | |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: AZ 30974) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2012-01-11 |