| NPI | 1205221520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0101X Pathology Anatomic Pathology (Licence: FL ME153175) |
| Additional Taxonomies | 207ZP0101X Pathology Anatomic Pathology (Licence: PA MT201181) |
| 207ZP0101X Pathology Anatomic Pathology (Licence: PA MD455497) | |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2022-01-06 |