| NPI | 1679548374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NY 301450-01) |
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NY 301450) |
| 174400000X Specialist (Licence: PA MD053119L) | |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2023-07-03 |