| NPI | 1417377169 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207ZC0006X Pathology, Clinical Pathology (Licence: GU M-2460)  | 
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: VA 0101261490)  | 
| Enumeration Date | 2014-04-21 | 
| Last Update Date | 2025-01-15 |