| NPI | 1720425572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MN 67856) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 60527) |
| 2080P0210X Pediatrics, Pediatric Nephrology (Licence: WI 60527) | |
| Enumeration Date | 2013-06-03 |
| Last Update Date | 2020-10-02 |