| NPI | 1578534566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: CA G87558) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: CA G87558) |
| 207ZC0500X Pathology, Cytopathology (Licence: CA G87558) | |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2020-03-10 |