| NPI | 1679796544 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207ZN0500X Pathology, Neuropathology (Licence: TX N1391) | 
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: LA MD 025469) | 
| Enumeration Date | 2007-04-10 | 
| Last Update Date | 2024-11-17 |