| NPI | 1609823681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: TX L9155) |
| Additional Taxonomies | 207ZP0105X Pathology Clinical Pathology/Laboratory Medicine (Licence: TX L9155) |
| 207ZP0213X Pathology Pediatric Pathology (Licence: TX L9155) | |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2023-03-28 |