| NPI | 1265450209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: PA MD447990) |
| Additional Taxonomies | 174400000X Specialist (Licence: MT 11116) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2013-10-09 |