| NPI | 1508845603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: FL ME148914) |
| Additional Taxonomies | 207ZP0101X Pathology Anatomic Pathology (Licence: IL 36105403) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2024-04-16 |