| NPI | 1578543294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: TX N6093) |
| Additional Taxonomies | 207ZC0500X Pathology, Cytopathology (Licence: KY 40115) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: VA 0101232047) | |
| 207ZC0500X Pathology, Cytopathology (Licence: TX N6093) | |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2014-10-31 |