| NPI | 1639639073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: WA MD61674465) |
| Additional Taxonomies | 207ZP0105X Pathology, Clinical Pathology/Laboratory Medicine (Licence: WA MD61674465) |
| 207ZP0101X Pathology, Anatomic Pathology (Licence: WA MD61674465) | |
| Enumeration Date | 2019-03-21 |
| Last Update Date | 2026-02-02 |