| NPI | 1083612501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: GA 028022) |
| Additional Taxonomies | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: AL 13929) |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2007-07-09 |