| NPI | 1396593513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MN 80414) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 80414) |
| Enumeration Date | 2024-05-13 |
| Last Update Date | 2026-06-16 |