| NPI | 1508887969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: CA G46715) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA G46715) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2014-06-06 |