| NPI | 1003444274 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207ZH0000X Pathology, Hematology (Licence: TX V6336) | 
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: TX V6336) | 
| Enumeration Date | 2020-04-01 | 
| Last Update Date | 2025-07-20 |