| NPI | 1710177712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZC0006X Pathology Clinical Pathology (Licence: FL OS18339) |
| Additional Taxonomies | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: MI 5101017197) |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: PA OS017048) | |
| Enumeration Date | 2007-07-26 |
| Last Update Date | 2022-01-19 |