| NPI | 1487856266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: FL ME147832) |
| Additional Taxonomies | 207ZP0101X Pathology, Anatomic Pathology (Licence: TN MD49161) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MD 22145) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MD D74236) | |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2020-12-16 |