| NPI | 1760429534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: MI 4301097520) |
| Additional Taxonomies | 207ZP0101X Pathology Anatomic Pathology (Licence: TX L8800) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2019-01-17 |