| NPI | 1134201825 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207ZP0105X Pathology, Clinical Pathology/Laboratory Medicine (Licence: OH 35047991)  | 
| Additional Taxonomies | 207ZI0100X Pathology, Immunopathology (Licence: OH 34047991)  | 
| 207ZP0101X Pathology, Anatomic Pathology (Licence: OH 35047991)  | |
| Enumeration Date | 2006-10-20 | 
| Last Update Date | 2008-06-05 |