| NPI | 1316043839 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: NY 002705) | 
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NY 002705) | 
| Enumeration Date | 2006-09-15 | 
| Last Update Date | 2021-01-20 |