| NPI | 1164411047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: TN 55903) |
| Additional Taxonomies | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: GA 044361) |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2019-08-19 |