| NPI | 1548294630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0101X Pathology Anatomic Pathology (Licence: FL ME113588) |
| Additional Taxonomies | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: MS 17808) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2013-03-19 |