| NPI | 1861506065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: GA 32065) |
| Additional Taxonomies | 207ZH0000X Pathology Hematology (Licence: GA 32065) |
| 207ZP0105X Pathology Clinical Pathology/Laboratory Medicine (Licence: GA 32065) | |
| 207ZP0213X Pathology Pediatric Pathology (Licence: GA 32065) | |
| 207ZC0500X Pathology Cytopathology (Licence: GA 32065) | |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2019-10-14 |