| NPI | 1407149792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: WA MD 00032775) |
| Additional Taxonomies | 207ZP0101X Pathology, Anatomic Pathology (Licence: CA G41864) |
| Enumeration Date | 2011-05-19 |
| Last Update Date | 2011-05-19 |