| NPI | 1205981933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: FL ME78499) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA C43162) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2014-11-19 |