| NPI | 1598733610 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: AZ 29217) | 
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: CO DR36542) | 
| Enumeration Date | 2006-03-14 | 
| Last Update Date | 2015-04-22 |