| NPI | 1346201209 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: UT 3403921205) | 
| Additional Taxonomies | 207ZH0000X Pathology, Hematology (Licence: NV 9291) | 
| 207ZH0000X Pathology, Hematology (Licence: CA G86484) | |
| 207ZH0000X Pathology, Hematology (Licence: UT 3403921205) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NV 9291) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: CA G86484) | |
| Enumeration Date | 2006-03-30 | 
| Last Update Date | 2013-10-29 |