| NPI | 1477642205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NE 23727) |
| Additional Taxonomies | 207ZP0101X Pathology, Anatomic Pathology (Licence: MN 48894) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2013-12-17 |