| NPI | 1497708937 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: MO R7089)  | 
| Additional Taxonomies | 207ZN0500X Pathology, Neuropathology (Licence: MO R7089)  | 
| Enumeration Date | 2006-05-18 | 
| Last Update Date | 2007-07-16 |