| NPI | 1790312023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: OH 35.155793) |
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MD D0103948) |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2026-06-12 |