| NPI | 1942379565 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207ZC0006X Pathology, Clinical Pathology (Licence: VA 0101029220) | 
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: VA 0101029220) | 
| Enumeration Date | 2006-11-07 | 
| Last Update Date | 2019-07-01 |