| NPI | 1568819308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0101X Pathology Anatomic Pathology (Licence: NH 22392) |
| Additional Taxonomies | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: MO 2016015535) |
| Enumeration Date | 2016-05-23 |
| Last Update Date | 2022-07-20 |