| NPI | 1659835148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: AL 37835) |
| Additional Taxonomies | 207ZF0201X Pathology Forensic Pathology (Licence: AL 37835) |
| 207ZF0201X Pathology Forensic Pathology (Licence: TN 41291) | |
| Enumeration Date | 2019-01-29 |
| Last Update Date | 2019-04-01 |