| NPI | 1063821940 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207ZP0105X Pathology, Clinical Pathology/Laboratory Medicine (Licence: FL ME169353)  | 
| Additional Taxonomies | 207ZP0101X Pathology, Anatomic Pathology (Licence: AR E-1000)  | 
| 207ZP0101X Pathology, Anatomic Pathology (Licence: WV 27989)  | |
| Enumeration Date | 2014-08-05 | 
| Last Update Date | 2024-11-01 |