| NPI | 1558353300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: OR MD224171) |
| Additional Taxonomies | 174400000X Specialist (Licence: NC 25750) |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2025-05-22 |