| NPI | 1629368667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NY 316967) |
| Additional Taxonomies | 207ZP0101X Pathology, Anatomic Pathology (Licence: NM MD2014-0934) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MN 58727) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NM MD2014-0934) | |
| Enumeration Date | 2011-04-11 |
| Last Update Date | 2022-08-15 |