| NPI | 1679501167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NJ 25MA04569300) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 255714) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2010-02-22 |