| NPI | 1699269753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MT MED-PHYS-LIC-143621) |
| Additional Taxonomies | 207ZP0105X Pathology, Clinical Pathology/Laboratory Medicine (Licence: WI 75962) |
| Enumeration Date | 2018-06-21 |
| Last Update Date | 2026-04-07 |