| NPI | 1346579984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: PA MT198717) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA ML60093443) |
| Enumeration Date | 2009-12-10 |
| Last Update Date | 2022-07-21 |