| NPI | 1043295983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0213X Pathology Pediatric Pathology (Licence: WA MD61241110) |
| Additional Taxonomies | 207ZP0213X Pathology Pediatric Pathology (Licence: MO 2008000417) |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: DC MD035218) | |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2022-04-04 |