| NPI | 1396793972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 207ZP0101X Pathology Anatomic Pathology (Licence: NJ 25MA06367700) |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: NJ 25MA06367700) | |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2017-11-22 |