| NPI | 1124133947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: MI 4301025988) |
| Additional Taxonomies | 207ZP0104X Pathology Chemical Pathology (Licence: MI 4301025988) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2007-07-08 |