| NPI | 1861981250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MS 35763) |
| Additional Taxonomies | 207ZP0101X Pathology, Anatomic Pathology (Licence: NC 2022-01454) |
| Enumeration Date | 2018-05-01 |
| Last Update Date | 2025-08-26 |