| NPI | 1194846568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: SC 28279) |
| Additional Taxonomies | 174400000X Specialist (Licence: NC 200300124) |
| 174400000X Specialist (Licence: SC 28279) | |
| 174400000X Specialist (Licence: CA A96188) | |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2013-08-07 |