| NPI | 1609847318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: VA 0101247106) |
| Additional Taxonomies | 207ZP0101X Pathology, Anatomic Pathology (Licence: MD D0023534) |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2010-08-29 |