| NPI | 1629153457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZH0000X Pathology Hematology (Licence: WA MD00044358) |
| Additional Taxonomies | 207ZP0101X Pathology Anatomic Pathology (Licence: WA MD00044358) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2011-11-28 |