| NPI | 1164736724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: NE 26554) |
| Additional Taxonomies | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: NE 5831) |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: OH 35121754) | |
| Enumeration Date | 2010-08-05 |
| Last Update Date | 2016-07-20 |