| NPI | 1083679310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: KY 26566) |
| Additional Taxonomies | 207ZP0101X Pathology Anatomic Pathology (Licence: KY 26566) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2020-06-02 |