| NPI | 1013254457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0101X Pathology Anatomic Pathology (Licence: NY 284366) |
| Additional Taxonomies | 207ZP0101X Pathology Anatomic Pathology (Licence: MA 249218) |
| Enumeration Date | 2013-01-04 |
| Last Update Date | 2023-01-28 |