| NPI | 1376502005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZI0100X Pathology Immunopathology (Licence: MN 31398) |
| Additional Taxonomies | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: MN 31398) |
| 207ZP0104X Pathology Chemical Pathology (Licence: MN 31398) | |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2007-09-11 |