| NPI | 1023045333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: MA 158613) |
| Additional Taxonomies | 207ZP0101X Pathology Anatomic Pathology (Licence: MA 158613) |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2013-11-21 |