| NPI | 1700078342 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NC 2007-01322)  | 
| Additional Taxonomies | 207ZH0000X Pathology, Hematology (Licence: CT 049879)  | 
| 207ZH0000X Pathology, Hematology (Licence: NJ 25MA08582300)  | |
| Enumeration Date | 2007-08-17 | 
| Last Update Date | 2024-03-01 |