| NPI | 1518179613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: OR MD21761) |
| Additional Taxonomies | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: WA MD00045473) |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: MN 39612) | |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2009-04-29 |