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Individual
DAVID OMAR HENRIQUEZ TICAS
Active
Individual
DAVID OMAR HENRIQUEZ TICAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
036164840
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/21/2017
Last updated
09/06/2023
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