| NPI | 1710337951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0105X Pathology, Clinical Pathology/Laboratory Medicine (Licence: MN 70239) |
| Additional Taxonomies | 207ZP0101X Pathology, Anatomic Pathology (Licence: MD D88693) |
| Enumeration Date | 2016-06-19 |
| Last Update Date | 2021-09-24 |