| NPI | 1548559529 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: UT 9693957-1205) | 
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MN 58991) | 
| Enumeration Date | 2011-03-30 | 
| Last Update Date | 2023-07-31 |