| NPI | 1841232105 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MI 4301040383)  | 
| Additional Taxonomies | 207ZI0100X Pathology, Immunopathology (Licence: MI 4301040383)  | 
| Enumeration Date | 2006-06-12 | 
| Last Update Date | 2011-09-15 |