| NPI | 1043604259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: FL ME134802) |
| Additional Taxonomies | 207ZP0105X Pathology, Clinical Pathology/Laboratory Medicine (Licence: FL ME134802) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NE 31898) | |
| Enumeration Date | 2015-03-25 |
| Last Update Date | 2021-06-02 |