| NPI | 1194201194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: FL ME177057) |
| Additional Taxonomies | 207ZP0105X Pathology, Clinical Pathology/Laboratory Medicine (Licence: WI 82143) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MO 2018018348) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MD d93145) | |
| Enumeration Date | 2018-07-13 |
| Last Update Date | 2025-10-16 |