| NPI | 1750812665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: NY 314478) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 314478) |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2023-07-17 |