| NPI | 1184680993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: NE 17631) |
| Additional Taxonomies | 207ZC0500X Pathology Cytopathology (Licence: NE 17631) |
| 207ZC0500X Pathology Cytopathology (Licence: IA 28682) | |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: IA 28682) | |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2010-06-08 |