| NPI | 1003294737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: NY 277589) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: NY 277589) |
| Enumeration Date | 2015-05-14 |
| Last Update Date | 2023-10-11 |