| NPI | 1811947757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MA 40042) |
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: FL ME65455) |
| 207ZC0006X Pathology, Clinical Pathology (Licence: PA MD488135) | |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2025-02-20 |