| NPI | 1679534432 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: WA MD60314310)  | 
| Additional Taxonomies | 207ZC0500X Pathology, Cytopathology (Licence: MT MED-PHYS-LIC-118222)  | 
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: ID M-12068)  | |
| 207ZC0500X Pathology, Cytopathology (Licence: WA MD60314310)  | |
| 207ZC0500X Pathology, Cytopathology (Licence: AK 165109)  | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: AK 165109)  | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MT MED-PHYS-LIC-118222)  | |
| 207ZC0500X Pathology, Cytopathology (Licence: ID M-12068)  | |
| 207ZC0500X Pathology, Cytopathology (Licence: WY 9164A)  | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: WY 9164A)  | |
| Enumeration Date | 2006-03-31 | 
| Last Update Date | 2025-09-30 |