| NPI | 1790761609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: SC 17972) |
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: TN 64720) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MO 101537) | |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2025-11-14 |