| NPI | 1962510164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0105X Pathology Clinical Pathology/Laboratory Medicine (Licence: SD 7122) |
| Additional Taxonomies | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: IA 33972) |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: MN 43293) | |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: SD 7122) | |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2022-04-08 |