| NPI | 1194737908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: CA G79234) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA G79234) |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2020-12-11 |