| NPI | 1083600019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: AZ 36721) |
| Additional Taxonomies | 207ZP0105X Pathology, Clinical Pathology/Laboratory Medicine (Licence: OH 81262) |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2016-02-22 |