| NPI | 1114908043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207ZC0500X Pathology Cytopathology (Licence: MA 156029) |
| Additional Taxonomies | 207ZP0101X Pathology Anatomic Pathology (Licence: MA 156029) |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2007-07-08 |