| NPI | 1104817022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: TX J4201) |
| Additional Taxonomies | 174400000X Specialist |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2024-05-16 |