| NPI | 1528089349 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: GA 064454)  | 
| Additional Taxonomies | 207ZN0500X Pathology, Neuropathology (Licence: SC 84997)  | 
| Enumeration Date | 2006-07-21 | 
| Last Update Date | 2020-10-01 |