| NPI | 1629408653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: MA 269645) |
| Additional Taxonomies | 207ZP0101X Pathology, Anatomic Pathology (Licence: MA 255977) |
| Enumeration Date | 2013-11-12 |
| Last Update Date | 2018-03-12 |