| NPI | 1386803179 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NY 256713) | 
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: IN 01070605A) | 
| Enumeration Date | 2008-06-05 | 
| Last Update Date | 2015-05-29 |