| NPI | 1710878632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: CA A204311) |
| Additional Taxonomies | 207ZP0101X Pathology, Anatomic Pathology (Licence: WA MD6162821) |
| Enumeration Date | 2025-07-10 |
| Last Update Date | 2025-08-18 |