| NPI | 1073578399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: TN 55160) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA C52183) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2016-12-15 |