| NPI | 1962400788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: SD 4169) |
| Additional Taxonomies | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: IA 34958) |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: MN 45138) | |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: NE 23218) | |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2013-02-25 |