| NPI | 1134249030 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207ZN0500X Pathology, Neuropathology (Licence: AL L4915SP)  | 
| Additional Taxonomies | 207ZN0500X Pathology, Neuropathology (Licence: NC 200700149)  | 
| 207ZP0105X Pathology, Clinical Pathology/Laboratory Medicine (Licence: NC 200700149)  | |
| Enumeration Date | 2007-04-02 | 
| Last Update Date | 2019-05-24 |