| NPI | 1679519912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: CA G46134) |
| Additional Taxonomies | 207ZP0104X Pathology Chemical Pathology (Licence: CA G46134) |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2016-01-27 |