| NPI | 1578552600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: KY 28784) |
| Additional Taxonomies | 207ZP0101X Pathology, Anatomic Pathology (Licence: KY 28784) |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2024-05-01 |