| NPI | 1922121102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: MI 4301102186) |
| Additional Taxonomies | 247ZC0005X Pathology Clinical Laboratory Director, Non-physician (Licence: NJ 25MA06996600) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2023-09-19 |