| NPI | 1972589653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: SD 2429) |
| Additional Taxonomies | 174400000X Specialist (Licence: SD 2429) |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2012-06-20 |