| NPI | 1982643912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: VA 0101254516) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA md426822) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NY 247802) | |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2023-03-10 |