| NPI | 1043269004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: MT 6630) |
| Additional Taxonomies | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: MN 46240) |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2007-07-08 |