| NPI | 1083610422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: FL ME96846) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A56040) |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2015-04-30 |