| NPI | 1679636211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: KS 04-31028) |
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MO 2005001739) |
| 207ZP0101X Pathology, Anatomic Pathology (Licence: MA 245331) | |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2011-05-24 |