| NPI | 1780004200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: VA 0101281602) |
| Additional Taxonomies | 207ZP0101X Pathology Anatomic Pathology (Licence: PA MD463101) |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2024-07-08 |