| NPI | 1821211053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZH0000X Pathology Hematology (Licence: WA MD60036064) |
| Additional Taxonomies | 207ZP0101X Pathology Anatomic Pathology (Licence: MA 218753) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2015-10-27 |