| NPI | 1720594104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: WI 73434-20) |
| Additional Taxonomies | 207ZP0101X Pathology Anatomic Pathology (Licence: CO TL.0005888) |
| Enumeration Date | 2017-12-20 |
| Last Update Date | 2020-08-03 |