| NPI | 1245493832 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MO 2003013950) | 
| Additional Taxonomies | 207ZF0201X Pathology, Forensic Pathology (Licence: MO 2003013950) | 
| Enumeration Date | 2008-07-03 | 
| Last Update Date | 2008-07-03 |