| NPI | 1730142902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MO 2007011168) |
| Additional Taxonomies | 207ZP0105X Pathology, Clinical Pathology/Laboratory Medicine (Licence: WI 48622) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: KS 04-32447) | |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2026-05-14 |