| NPI | 1023225489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: WA MD60022124) |
| Additional Taxonomies | 207ZP0101X Pathology, Anatomic Pathology (Licence: MO 2005016639) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2009-04-13 |