| NPI | 1962474056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: PA MD050150L) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD050150L) |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2018-04-12 |