| NPI | 1023009834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: CA C151388) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0101236850) |
| 207ZH0000X Pathology, Hematology (Licence: CA C151388) | |
| Enumeration Date | 2005-11-01 |
| Last Update Date | 2023-06-19 |