| NPI | 1497734917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: VA 0101277882) |
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: CO CDRH.0040582) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: CO DR40582) | |
| 207ZP0105X Pathology, Clinical Pathology/Laboratory Medicine (Licence: WI 53072) | |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2023-06-08 |