| NPI | 1790103208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: MA 276415) |
| Additional Taxonomies | 207ZP0101X Pathology Anatomic Pathology (Licence: MA 276415) |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: MA 260332) | |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2024-02-28 |