| NPI | 1225082225 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207ZP0105X Pathology, Clinical Pathology/Laboratory Medicine (Licence: WA 00030432) | 
| Additional Taxonomies | 207ZP0101X Pathology, Anatomic Pathology (Licence: WA 00030432) | 
| Enumeration Date | 2006-05-22 | 
| Last Update Date | 2008-09-10 |