| NPI | 1982067039 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207ZC0006X Pathology, Clinical Pathology (Licence: MI 4301506004) | 
| Additional Taxonomies | 207ZN0500X Pathology, Neuropathology (Licence: IA MD-46582) | 
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: IA MD-46582) | |
| Enumeration Date | 2016-04-05 | 
| Last Update Date | 2022-10-24 |