| NPI | 1306896543 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: SC 12067) | 
| Additional Taxonomies | 207ZC0500X Pathology, Cytopathology (Licence: SC 12067) | 
| Enumeration Date | 2006-05-10 | 
| Last Update Date | 2010-11-11 |