| NPI | 1003893165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: OH 35.038575) |
| Additional Taxonomies | 174400000X Specialist (Licence: OH 35038575) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2013-11-26 |