| NPI | 1508870544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: ND 11478) |
| Additional Taxonomies | 207ZC0500X Pathology Cytopathology (Licence: MN 48675) |
| 207ZP0101X Pathology Anatomic Pathology (Licence: MN 48675) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2021-06-22 |