| NPI | 1679765192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SD 0058) |
| Additional Taxonomies | 207ZP0101X Pathology, Anatomic Pathology (Licence: SD 0058) |
| Enumeration Date | 2007-08-17 |
| Last Update Date | 2007-08-17 |