| NPI | 1659356475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: OH 35-062217V) |
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NY 159909) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MI 4301084989) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: PA MD030781E) | |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2007-07-08 |