| NPI | 1659874972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0101X Pathology Anatomic Pathology (Licence: MI 4301114160) |
| Additional Taxonomies | 207ZC0500X Pathology Cytopathology (Licence: PA MD461772) |
| 207ZC0500X Pathology Cytopathology (Licence: MI 4301114160) | |
| Enumeration Date | 2018-03-13 |
| Last Update Date | 2019-06-05 |