| NPI | 1528063237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0101X Pathology Anatomic Pathology (Licence: NY 117089) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 117089) |
| 207ZP0105X Pathology Clinical Pathology/Laboratory Medicine (Licence: NY 117089) | |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2019-10-09 |