| NPI | 1790777142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MS 11872) |
| Additional Taxonomies | 174400000X Specialist (Licence: MS 11872) |
| Enumeration Date | 2005-08-20 |
| Last Update Date | 2007-11-07 |