| NPI | 1881959849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: TX T2598) |
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MI 4301100387) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: ND 14039) | |
| Enumeration Date | 2012-07-05 |
| Last Update Date | 2021-10-13 |