| NPI | 1184890121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: KY 03218) |
| Additional Taxonomies | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: TN 1893) |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: TX N0481) | |
| Enumeration Date | 2008-04-30 |
| Last Update Date | 2013-02-06 |