| NPI | 1912515099 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NE 36125) | 
| Additional Taxonomies | 207ZH0000X Pathology, Hematology (Licence: IA MD-54596) | 
| 207ZH0000X Pathology, Hematology (Licence: NE 36125) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NE TEP8811) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: IA MD-54596) | |
| Enumeration Date | 2020-07-15 | 
| Last Update Date | 2025-07-22 |