| NPI | 1548267164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: CA G44156) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA G044156) |
| Enumeration Date | 2005-06-29 |
| Last Update Date | 2018-02-01 |