| NPI | 1366456840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0101X Pathology Anatomic Pathology (Licence: MO 36579) |
| Additional Taxonomies | 207ZP0105X Pathology Clinical Pathology/Laboratory Medicine (Licence: MO 36579) |
| 207ZF0201X Pathology Forensic Pathology (Licence: MO 36579) | |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2017-01-17 |