| NPI | 1063035749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MN 79224) |
| Additional Taxonomies | 207ZF0201X Pathology, Forensic Pathology (Licence: WI 81421-21) |
| Enumeration Date | 2020-05-28 |
| Last Update Date | 2025-05-06 |