| NPI | 1598869091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: OR MD169999) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MD00035593) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2016-03-24 |