| NPI | 1548883606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZF0201X Pathology, Forensic Pathology (Licence: MN 82712) |
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: RI DO01271) |
| 207ZP0213X Pathology, Pediatric Pathology (Licence: MA 1018915) | |
| 208D00000X General Practice (Licence: RI DO01271) | |
| Enumeration Date | 2020-05-24 |
| Last Update Date | 2026-06-29 |