| NPI | 1720032907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MI 4301095797) |
| Additional Taxonomies | 207ZP0101X Pathology, Anatomic Pathology (Licence: PA MD-073135-L) |
| 207ZP0101X Pathology, Anatomic Pathology (Licence: NY 243-083-1) | |
| 207ZP0105X Pathology, Clinical Pathology/Laboratory Medicine (Licence: TX L7125) | |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2019-01-17 |