| NPI | 1629047477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: CO 27968) |
| Additional Taxonomies | 207ZP0213X Pathology, Pediatric Pathology (Licence: CO 27968) |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2015-04-03 |