| NPI | 1912317884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: NJ 25IA13100000) |
| Additional Taxonomies | 207ZP0101X Pathology, Anatomic Pathology (Licence: MI 4301114603) |
| Enumeration Date | 2014-05-01 |
| Last Update Date | 2026-05-26 |