| NPI | 1275593147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: OH 35057856) |
| Additional Taxonomies | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: MI 4301044046) |
| 207ZP0104X Pathology Chemical Pathology (Licence: MI 4301044046) | |
| 207ZP0104X Pathology Chemical Pathology (Licence: OH 35057856) | |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2014-11-13 |