| NPI | 1174571178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: LA 15473R) |
| Additional Taxonomies | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: PA MD425000) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2009-10-21 |