| NPI | 1790771509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246Q00000X Specialist/Technologist, Pathology (Licence: NY 1905731) |
| Additional Taxonomies | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: NY 190573) |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2023-03-27 |