| NPI | 1316917784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: SC 21835) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME64789) |
| 174400000X Specialist (Licence: AZ 23263) | |
| 174400000X Specialist (Licence: SC 21835) | |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2020-08-25 |