| NPI | 1346262441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: VA 0101231650) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: MD D0053886) |
| 171000000X Military Health Care Provider (Licence: VA 0101231650) | |
| 207ZD0900X Pathology, Dermatopathology (Licence: VA 0101231650) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2023-12-13 |