| NPI | 1003899873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: MD D25865) |
| Additional Taxonomies | 207ZP0007X Pathology, Molecular Genetic Pathology (Licence: MD D0025865) |
| 207ZP0101X Pathology, Anatomic Pathology (Licence: MD d0025865) | |
| 208D00000X General Practice (Licence: MD D25865) | |
| Enumeration Date | 2005-11-24 |
| Last Update Date | 2019-08-05 |