| NPI | 1164629713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZF0201X Pathology, Forensic Pathology (Licence: VA 0101257810) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2026-01-13 |