| NPI | 1669410999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: TX M4579) |
| Additional Taxonomies | 207ZP0105X Pathology, Clinical Pathology/Laboratory Medicine (Licence: TX FTL 40611) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2012-07-27 |