| NPI | 1083000285 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: TN 65982)  | 
| Additional Taxonomies | 207ZP0101X Pathology, Anatomic Pathology (Licence: MI 4301116374)  | 
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MI 4301116374)  | |
| Enumeration Date | 2015-04-14 | 
| Last Update Date | 2022-07-13 |