| NPI | 1043279375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: WA MD00018566) |
| Additional Taxonomies | 207ZP0213X Pathology Pediatric Pathology (Licence: WA MD00018566) |
| 208000000X Pediatrics (Licence: WA MD00018566) | |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2007-12-18 |