| NPI | 1487652293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: TX P8393) |
| Additional Taxonomies | 207ZP0101X Pathology Anatomic Pathology (Licence: NY 231381-1) |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2014-05-12 |