| NPI | 1609813914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207ZN0500X Pathology Neuropathology (Licence: RI MD09362) |
| Additional Taxonomies | 207ZP0101X Pathology Anatomic Pathology (Licence: RI MD09362) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2007-07-08 |