| NPI | 1073543575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: GA 057934) |
| Additional Taxonomies | 207ZP0101X Pathology, Anatomic Pathology (Licence: OH 35053216B) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2012-10-29 |