| NPI | 1255972527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: TN 69822) |
| Additional Taxonomies | 207ZP0213X Pathology, Pediatric Pathology (Licence: PA MT218061) |
| Enumeration Date | 2019-10-08 |
| Last Update Date | 2024-08-08 |