| NPI | 1639554181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: NY 298212) |
| Additional Taxonomies | 207ZH0000X Pathology Hematology (Licence: NY 298212) |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: OK 31464) | |
| Enumeration Date | 2015-07-27 |
| Last Update Date | 2021-10-30 |