| NPI | 1821213265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: PA MT185480) |
| Additional Taxonomies | 207ZP0101X Pathology Anatomic Pathology (Licence: NY 262620) |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2023-10-20 |