| NPI | 1003886987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: SC 5683) |
| Additional Taxonomies | 174400000X Specialist (Licence: SC 5683) |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2007-12-20 |