| NPI | 1255329926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: SC 19352) |
| Additional Taxonomies | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: NC 93-00286) |
| Enumeration Date | 2005-10-07 |
| Last Update Date | 2021-11-08 |