| NPI | 1720423270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: VA 0101281492) |
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: TX 46771) |
| 207ZP0101X Pathology, Anatomic Pathology (Licence: AL 45503) | |
| Enumeration Date | 2013-05-09 |
| Last Update Date | 2024-05-01 |