| NPI | 1861820573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0101X Pathology Anatomic Pathology (Licence: MA 266814) |
| Additional Taxonomies | 207ZP0101X Pathology Anatomic Pathology (Licence: MA 255500) |
| Enumeration Date | 2013-10-16 |
| Last Update Date | 2017-08-15 |