| NPI | 1043209042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: WV 23275) |
| Additional Taxonomies | 207ZC0006X Pathology Clinical Pathology (Licence: MN 70848) |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: WI 40604-020) | |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: MT 10897) | |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2022-05-05 |