| NPI | 1023637378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: ND 22423) |
| Additional Taxonomies | 207ZH0000X Pathology Hematology (Licence: MI 4301510541) |
| 207ZH0000X Pathology Hematology (Licence: ND 22423) | |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: MI 4301510541) | |
| Enumeration Date | 2020-04-15 |
| Last Update Date | 2025-06-30 |