| NPI | 1093761595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: AZ 77189) |
| Additional Taxonomies | 174400000X Specialist (Licence: UT 263694-1205) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2025-06-10 |