| NPI | 1770045403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: WA MD.MD.70125833) |
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: WA MD.MD.70125833) |
| Enumeration Date | 2019-04-02 |
| Last Update Date | 2026-08-27 |