| NPI | 1013280130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: FL ME 100793) |
| Additional Taxonomies | 207ZC0500X Pathology, Cytopathology (Licence: FL ME 100793) |
| 207ZC0500X Pathology, Cytopathology (Licence: NY 198886-1) | |
| 207ZP0101X Pathology, Anatomic Pathology (Licence: FL ME 100793) | |
| 207ZP0101X Pathology, Anatomic Pathology (Licence: NY 198886-1) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NY 198886-1) | |
| Enumeration Date | 2012-02-21 |
| Last Update Date | 2012-05-30 |