| NPI | 1700298460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: VA 0101272194) |
| Additional Taxonomies | 207ZP0101X Pathology Anatomic Pathology (Licence: VA 0101272194) |
| 207ZP0105X Pathology Clinical Pathology/Laboratory Medicine (Licence: VA 0101272194) | |
| Enumeration Date | 2014-05-28 |
| Last Update Date | 2021-05-27 |