| NPI | 1467839571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: IN 01077013A) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2015-04-28 |
| Last Update Date | 2023-07-14 |