| NPI | 1720025893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NH 21472) |
| Additional Taxonomies | 207ZP0101X Pathology, Anatomic Pathology (Licence: MA 81423) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2021-08-05 |