| NPI | 1144859489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: TX V5714) |
| Additional Taxonomies | 207ZC0006X Pathology, Clinical Pathology (Licence: TX V5714) |
| 207ZC0006X Pathology, Clinical Pathology (Licence: UT 12404264-1205) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: UT 12404264-1205) | |
| Enumeration Date | 2020-04-08 |
| Last Update Date | 2025-08-04 |