| NPI | 1104899434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: FL ME100238) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 183233-1) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2010-09-01 |