| NPI | 1568881415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: FL ME145017) |
| Additional Taxonomies | 207ZC0006X Pathology Clinical Pathology (Licence: MI 4301104837) |
| 207ZP0101X Pathology Anatomic Pathology (Licence: MI 4301104837) | |
| Enumeration Date | 2014-04-08 |
| Last Update Date | 2020-07-06 |