| NPI | 1265419089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: KY 25913) |
| Additional Taxonomies | 207ZH0000X Pathology Hematology (Licence: KY 25913) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2012-09-11 |