| NPI | 1649255449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: AZ 35979) |
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: FL ME94604) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: OH 86942) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: CO DR42367) | |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2023-01-04 |