| NPI | 1063481216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: CO 19412) |
| Additional Taxonomies | 207ZP0213X Pathology, Pediatric Pathology (Licence: CO 19412) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2014-03-11 |