| NPI | 1992883250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: CO 34562) |
| Additional Taxonomies | 207ZC0500X Pathology Cytopathology (Licence: CO 34562) |
| 207ZF0201X Pathology Forensic Pathology (Licence: CO 34562) | |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: NM 96-305) | |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: MT 8736) | |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: WY 6254A) | |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2013-06-18 |