| NPI | 1578236659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 14245015-1205) |
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MN 31764) |
| 207ZP0105X Pathology, Clinical Pathology/Laboratory Medicine (Licence: MN 72164) | |
| Enumeration Date | 2021-07-26 |
| Last Update Date | 2025-10-14 |