| NPI | 1568457893 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: CT 046164) |
| Additional Taxonomies | 174400000X Specialist (Licence: CT 046164) |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2022-09-13 |