| NPI | 1003871815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZH0000X Pathology, Hematology (Licence: TN 46486) |
| Additional Taxonomies | 207ZP0101X Pathology, Anatomic Pathology (Licence: PA MD430689) |
| 207ZP0105X Pathology, Clinical Pathology/Laboratory Medicine (Licence: MI 4301081425) | |
| 207ZH0000X Pathology, Hematology (Licence: NJ 25MA08843800) | |
| 207ZP0101X Pathology, Anatomic Pathology (Licence: OK 17073) | |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2019-05-16 |