| NPI | 1639533805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: UT 12284461-1205) |
| Additional Taxonomies | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: MN 62627) |
| 207ZP0213X Pathology Pediatric Pathology (Licence: UT 12284461-1205) | |
| Enumeration Date | 2016-04-13 |
| Last Update Date | 2022-03-29 |