| NPI | 1790218725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: KS 05-51304) |
| Additional Taxonomies | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: MO 2021004747) |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: TX T6221) | |
| Enumeration Date | 2017-04-06 |
| Last Update Date | 2025-08-27 |