| NPI | 1174512867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0101X Pathology Anatomic Pathology (Licence: MA 79108) |
| Additional Taxonomies | 174400000X Specialist (Licence: MA 79108) |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2014-12-19 |