| NPI | 1942544721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: CO 63409) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A122577) |
| 207ZP0007X Pathology Molecular Genetic Pathology (Licence: TN 53245) | |
| Enumeration Date | 2012-11-19 |
| Last Update Date | 2020-03-02 |