| NPI | 1881787877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: FL ME 97446) |
| Additional Taxonomies | 174400000X Specialist (Licence: NC 2006-01115) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2008-05-15 |