| NPI | 1619379302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: KS 04-43165) |
| Additional Taxonomies | 207ZP0101X Pathology Anatomic Pathology (Licence: TX BP10062278) |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: MI 4301104547) | |
| Enumeration Date | 2014-09-24 |
| Last Update Date | 2023-08-24 |