| NPI | 1477511285 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: WA MD60095416)  | 
| Additional Taxonomies | 207ZC0500X Pathology, Cytopathology (Licence: GA 49803)  | 
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: ID M-10794)  | |
| 207ZC0500X Pathology, Cytopathology (Licence: MT MEDPHYSLIC12185)  | |
| 207ZC0500X Pathology, Cytopathology (Licence: ID M-10794)  | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MT MEDPHYSLIC12185)  | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: GA 49803)  | |
| 207ZC0500X Pathology, Cytopathology (Licence: WA MD60095416)  | |
| Enumeration Date | 2006-05-02 | 
| Last Update Date | 2025-09-19 |