| NPI | 1114911021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: VA 0101224516) |
| Additional Taxonomies | 207ZC0500X Pathology, Cytopathology (Licence: VA 0101224516) |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2008-09-17 |