| NPI | 1053372912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: NV 10192) |
| Additional Taxonomies | 207ZH0000X Pathology Hematology (Licence: NV 10192) |
| 207ZH0000X Pathology Hematology (Licence: CA G86741) | |
| 207ZH0000X Pathology Hematology (Licence: OH 35066478) | |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: OH 35066478) | |
| Enumeration Date | 2006-03-30 |
| Last Update Date | 2014-01-08 |