| NPI | 1124097647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: WA MD00017652) |
| Additional Taxonomies | 207ZH0000X Pathology Hematology (Licence: WA MD00017652) |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2007-12-18 |