| NPI | 1558939249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MN 79746) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX T9117) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: TX BP10074434) | |
| Enumeration Date | 2021-06-17 |
| Last Update Date | 2025-05-16 |