NPI | 1245204155 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: FL ME100496) |
Additional Taxonomies | 171000000X Military Health Care Provider (Licence: PA MD425234) |
Enumeration Date | 2006-02-15 |
Last Update Date | 2022-07-26 |