| NPI | 1164492997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: IA 33649) |
| Additional Taxonomies | 208600000X Surgery (Licence: IA 33649) |
| 207ZC0500X Pathology, Cytopathology (Licence: IA 33649) | |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2013-12-17 |