| NPI | 1902109564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: UT 12919332-1205) |
| Additional Taxonomies | 207ZH0000X Pathology, Hematology (Licence: CA A109472) |
| 207ZP0101X Pathology, Anatomic Pathology (Licence: CA A109472) | |
| Enumeration Date | 2010-12-20 |
| Last Update Date | 2022-08-28 |